Brain death and organ donation: you can have one without the other.

Brain Death and Organ Donation: You Can Have One Without the Other Brain death and organ transplantation are so closely linked that is sometimes seems you can't have one without the other. This is certainly true in transplantation, which requires a brain dead corpse whose circulation is maintained by mechanical ventilation to preserve the organs. The converse, of course, is not true: transplantation does not have to be contemplated for a determination of brain death. But what recourse, if any, do the parents of a brain dead child have if a hospital refuses to release the body of their child to them unless they agree to organ donation? And what response should hospital administrators, hospital lawyers, and courts give when physicians ask them for directives on how to practice medicine? These questions were recently put to the New Jersey Supreme Court in Strachan v. John F. Kennedy Memorial Hospital, a case in which physicians, hospital adminstrators and lawyers all failed in their duties to the deceased's family. His Organs or No Body At 4:30 p.m. on Friday, April 25, 1980, twenty-year-old Jeffrey Strachan intentionally shot himself in the head. He was rushed to the emergency room of New Jersey's John F. Kennedy Memorial Hospital. By 5:25 p.m. spontaneous respiration had ceased. The emergency room physician placed the young man on a mechanical ventilator, advised his parents that their son was "brain dead," and asked them to consider donating his organs. At 8:10 p.m. a neurologist confirmed that Jeffrey was dead, and again asked the parents if they would donate their son's organs. When the parents could not decide, the neurologist suggested that they think about it and return in the morning. The neurologist wrote in Jeffrey's chart: ...this patient is brain dead. At present we are working with parents trying to obtain permission to harvest kidney and corneas and possibly heart. Our staff is working with transplant team personnel in this effort. If they get permission to harvest, proceed. A representative of the Delaware Valley Transplant Program advised the parents that a decision would have to be made by 11:00 a.m. the next day, as thereafter the organs would deteriorate. On Saturday morning the father informed the attending physician in the ICU, to which Jeffrey had been transferred, that he and his wife did not wish to donate their son's organs and wanted him removed from "life support" systems. The physician asked them to think about it further, but nonetheless wrote in the chart: "The family has decided not to permit the harvesting of any organs [the neurologist] ... is informed; the case is dismissed." The phrase "case dismissed" apparently meant that the organ procurement agency would no longer consider using the organs for transplant. Jeffrey's father returned to the hospital on Saturday evening. He spoke with another neurologist who confirmed (again) that his son was dead. The new neurologist informed Mr. Strachan that his son would be removed from mechanical support systems "as soon as the hospital administrator tells us the procedure...." Late Saturday evening, the hospital administrator called the hospital lawyer, who advised him to "run EEGs until we have a clear understanding of what the boy's condition is and on Monday discuss further what to do and if necessary call the Prognosis Committee together." The lawyer also indicated that if the Strachans wanted their son's body before Monday, they would have to obtain a court order. The family was so advised at 2:00 a.m. Sunday morning. EEGs were performed on Sunday and Monday. At 9:40 a.m. on Monday morning, yet another physician examined Jeffrey and again concluded that he was dead. At 2:00 p.m. he noted in the chart, "patient officially brain dead...." At 2:30 p.m. the parents were informed that the respirator would be removed if they would sign a release prepared by the hospital lawyer. …