Why I can no longer work at Papworth
We present one of the many voices suggesting that prelation of organs may be murder, when only the brain seems dead. Last February the press reported that in California one Gary Docker, 42, a former policeman in Chattanooga, Tennessee, suddenly revived after 7 1/2 years of being "brain-dead". But the medical mafia is too hungry for quick profits to wait even seven hours before starting to cut.
THE DAILY TELEGRAPH
Tuesday, April 19, 1988Dr. David Wainwright Evans, a consultant cardiologist who has worked at the hospital since 1967, has left because of his opposition to transplant surgery. Here he explains why it should stop.
I have retired early from my post as consultant cardiologist because I firmly believe transplants to be wrong. My base was at Papworth in the East Anglia health region where the surgical activity is ever more dominated by transplantation.
Believing that heart and lung transplants should not be going on at all, it was distressing to see patients waiting for many dangerous months for less dramatic operations such as coronary by-pass grafts and heart valve replacements. My protests about transplantation fell upon deaf ears, of course, because it is now so heavily backed by the DHSS and the medical establishment. Some of my more public utterances understandably incurred the displeasure of my employer. I decided the only way to achieve peace of mind was to retire as early as practically possible.
I refuse to be associated with cardiac transplantation because it necessitates the removal of a beating heart from a young person before that person is indisputably dead. That young person will have been certified dead before the operation to remove the heart begins, but this is done on so-called "brain-death" criteria. These do not establish that the whole of the brain is dead but are supposed to establish that the capacity for consciousness and the ability to breathe spontaneously have been irretrievably lost.
This is the new concept and definition of death which some people wish to impose on the medical profession and on society. In this country, the tests used to diagnose this condition consider only the brain stem, which connects the bulk of the brain (the cerebral hemispheres) to the spinal chord. The brain stem contains the vital centers that control breathing, blood pressure and heart rate. Of these, only the breathing center has to be unresponsive to one of the challenges.
Some reflexes involving the brain stem are also required to be absent, such as eye reflexes and the response to ice-cold saline injected into the ears.
When these criteria are satisfied, it is said that there is no possibility of any degree of consciousness returning and that death in the commonly understood sense of the term, ie, final cessation of the circulation, will inevitably occur within a few days, despite continuing mechanical ventilation. That being so, it is held that a patient in that state can be regarded for all intents and purposes as already dead.
I cannot accept this, principally because there may be some circulation and a lot of activity still going on in untested parts of the brain. We simply do not know enough about how the brain works to dismiss any residual activity as having no significance. However reliable the "brainstem death" criteria are fro forecasting that the patient is going to die, they do not suffice for the diagnosis and cirtifiation of death itself.
I would go on treating a patient in that state as a human being deserving of our every care and consideration. I could not regard that person as a corpse with a beating heart. I would discontinue mechanical ventilation in the patient's interest were it to become clear that the outlook was hopeless.
A donor appears to be alive, of course, as the operation to remove the heart begins. The person is pink, warm and respiring (with the aid of a respirator). Indeed all his organs are working. The person bleeds when cut and his blood pressure and heart rate may increase dramatically - responses which in any other operation would be an indication that to the anaesthetist to increase the anaesthetic in case his patient might be feeling pain!
In the context of donor organ removal removal, during which, as a rule, no general anaesthetic is given - all this is tolerable to those involved in the operation because they are sincerely convinced that there is no possibility of the donor experiencing any distress. They may well be right, indeed I hope very much that they are right. But I am not quite so sure.
For me, as for others of my colleagues, the answer has to be to disassociate myself from this procedure. In my case this has meant leaving a hospital where I was once proud and very happy to work. My sadness at leaving so many wonderful colleagues and the patients I loved can be imagined. But the relief is enormous and now, at last, I can say some things that needed to be said.
In making my feelings known, I am deeply sensitive to the possibility of distressing some who may have given permission for relatives to be used as donors and some who have received organs from others. To them I would say that everything that was done was done in good faith and with the very best and most altruistic of motives. These questions may discomfit some people but they are questions I believe must be asked lest we find ourselves on a very slippery slope indeed.
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