More hot water for author of column on brain death

The transplant community erupted over an editorial published March 13 by The Wall Street Journal that questioned brain death protocols for organ donation. Now, a prominent physician quoted in the article is questioning author Dick Teresi's credibility.

Teresi wrote an opinion piece entitled, "What you lose when you sign that donor card," that was adopted from his new book, "The undead: Organ harvesting, the ice-water test, beating-heart cadavers—How medicine is blurring the line between life and death." In the column, Teresi suggests that the transplant community does an inadequate job ensuring that some one is functionally dead before harvesting their organs.

"The exam for brain death is simple. A doctor splashes ice water in your ears (to look for shivering in the eyes), pokes your eyes with a cotton swab and checks for any gag reflex, among other rudimentary tests. It takes less time than a standard eye exam. Finally, in what's called the apnea test, the ventilator is disconnected to see if you can breathe unassisted. If not, you are brain dead. (Some or all of the above tests are repeated hours later for confirmation.)," wrote Teresi. "Here's the weird part. If you fail the apnea test, your respirator is reconnected. You will begin to breathe again, your heart pumping blood, keeping the organs fresh. Doctors like to say that, at this point, the 'person' has departed the body. You will now be called a BHC, or beating-heart cadaver. Still, you will have more in common biologically with a living person than with a person whose heart has stopped. Your vital organs will function, you'll maintain your body temperature, and your wounds will continue to heal. You can still get bedsores, have heart attacks and get fever from infections."

The article resulted in a firestorm of comments (still posted on the WSJ website are 573 comments and more than 1,000 tweets), many from surgeons who said Teresi over-simplified describing the tests for brain death and that he quoted outdated research. Organ recipients also chimed in, saying that his words would hurt donation in a field where demand outstrips supply. National Public Radio interviewed him; Transplant News editor Jim Warren said in his letter to WSJ: "Dick Teresi's article … is the most malicious, potentially damaging and ill informed piece on the topics of organ and tissue donation I have seen in my 36 years in the field."

And, on April 5, WSJ had to run a correction, from the author, about how he quoted Robert Truog, a professor of medical ethics, anesthesia, and pediatrics at Harvard Medical School, who Teresi claimed compared pain in an organ donor to "whether it was OK to kick a rock." Aside from the change in the language, Truog denied even using the analogy. WSJ also had to run a correction on the article about the cost of organ transplants.

Many would say "any press is good press," and that the comments that the article generated from transplant professionals and organ donors actually shed a positive light on the value of transplantation. Teresi may sell more books because of it, but his credibility will no doubt be questioned.

Note: Teresi's original column can be found here, but a subscription to The Wall Street Journal is required.