Year in review in intensive care medicine, 2004. II. Brain injury, hemodynamic monitoring and treatment, pulmonary embolism, gastrointestinal tract, and renal failure

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The mismatching of demand and supply for organ donation has been highlighted in Intensive Care Medicine this year. A group from Paris [1] reported on their survey of patients admitted in severe coma in which they examined the implications for brain death identification and organ donation. This well conducted survey concludes that increasing the number of hospital donor/transplant coordinators in collaboration with mobile emergency units had led to identification of more comatose patients in ICU and more brain-dead patients. This endeavor had a direct effect on increasing the organ donation rate. This interesting report was accompanied by an editorial by Park [2]. The mismatch between demand and supply of organs was commented upon again and alternatives considered. These of course include living relative donation and the attendant risk of surgery, anesthesia, and postoperative care of the previously well donor. Opting-in, opting-out, presumed consent, and the logistics of donating nonbeating hearts were reviewed. While both of these contributions are commendable, one may be led to the conclusion that the diagnosis of brain death (or brainstem death) is made to facilitate organ donation. In an editorial entitled “Brain death” Russell [3] emphasizes the importance of making the concept of brain death a reflection of our moral and philosophical ideas of what it means to be alive or dead and should not in any way be linked to the need for organ donation/transplantation and that a human being should be declared brain dead only because he/she is in fact dead. The concept of brain death that is in use should not be influenced by any other criteria, regardless of important such criteria may be to other human beings. …