PRO-LIFE BASICS: How do doctors determine whether a patient is brain dead?

I read your column about how to know whether someone is really dead—but how do doctors determine whether a patient is brain dead? —Christina, Virginia

Every set of criteria for “brain death” includes an apnea test. (“Apnea” means the absence of breathing.) This test, which has no benefit for the comatose patient and can aggravate the patient’s already compromised condition, is done without the knowledge or informed consent of family members. When a patient is receiving oxygen and getting rid of carbon dioxide through a ventilator, turning off the ventilator to see if he can breathe on his own may be harmful.

The resulting lack of oxygen and accumulation of carbon dioxide in the body would be dangerous even in a largely healthy human. When the brain, heart, lungs or other vital organs are in a damaged state, even small periods without breathing will further damage them. The apnea test, during which the ventilator is turned off for up to 10 minutes, can induce a decrease in blood pressure or cardiac arrest.

The sole purpose of the apnea test is to determine the patient’s ability or inability to breathe on his/her own in order to declare him/her “brain dead.” It is illogical to perform a stressful, possibly lethal, apnea test on a patient who has just undergone severe head trauma. Turning off the ventilator for up to 10 minutes brings about the risk of killing a comatose patient who might otherwise survive and recover if treated long enough.

Many people have signed up to be an organ donor after death. However, most people are probably unaware that before the patient is declared “brain dead,” the transplant physician must perform this test on a patient. Without the apnea test, the diagnosis of “brain death” is impossible, and without the diagnosis of “brain death,” the transplantation of unpaired vital organs is not permissible.

Medical professionals in the transplant system often refuse to publicly acknowledge the detrimental effects of the apnea test. They also reject obtaining written consent to do the apnea test because, if the apnea test were explained in detail, family members probably would refuse to authorize it.

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About the author

Dr. Paul Byrne

Dr. Paul Byrne is former president of the Catholic Medical Association. He writes from Ohio, where he is a neonatologist. He has been published extensively in medical, legal and lay media.