When are you really dead? Study aims to dispel myths, remove barriers to organ donation

A study led by eastern Ontario’s children’s hospital is seeking to better understand the dying process and help address families’ fears around organ donation. 

Researchers at the Ottawa hospital worked with family members of adult patients in intensive care units in Canada, the Netherlands and the Czech Republic, tracking the patients’ vital signs for 30 minutes after death had been declared.

It’s the largest international study of its kind, involving more than 631 families, according to CHEO. The findings were published in the Jan. 28 issue of the New England Journal of Medicine. 

“[We] wanted to provide real scientific evidence to inform the dying process and hopefully dispel some myths and misunderstandings,” said Dr. Sonny Dhanani, the study’s lead investigator and the chief of the Ottawa hospital’s pediatric intensive care unit. 

Belief patients could come back to life

Dhanani said he’s concerned Canadians aren’t embracing organ donations, in part due to a belief that patients in intensive care units who were taken off life support could come back to life. 

“Because of stories about people coming back to life [that exist] even within the medical community … we were worried that organ donation wasn’t being offered, or that grieving family members weren’t consenting to donation,” Dhanani told CBC Radio’s All In A Day.

Dr. Sonny Dhanani’s study monitored the vital signs of patients for 30 minutes after they were taken off life support, in an attempt to better understand the dying process. (University of Ottawa)

The study looked at patients who had life support withdrawn and monitored their heart rate, blood pressure and oxygen levels after death was determined. It found that even after flatlining a patient’s heart activity can stop and restart several times before coming to a final end.

In 14 per cent of cases, patients had both their heartbeat and their blood pressure restart, Dhanani said. The longest time between the heart stopping and restarting was four minutes and 20 seconds. 

When those patients have had a “catastrophic illness,” there’s ultimately no hope for recovery, he said.

The standard, Dhanani said, is to wait five minutes after life support is withdrawn to begin recovering a person’s organs.

“[Now] we can explain this process,” he said. “We have more information scientifically of how death occurs in the intensive care unit.”

According to the Canadian Organ Replacement Register, more than 4,300 people were waiting for an organ in 2018.

Despite the sensitive nature of the study, 93 per cent of families approached agreed to take part, Dhanani said, a sign families “really understood what we were doing.” The study was funded by the Canadian Institutes for Health Research. 

Dhanani said the study’s results could be embedded into the organ donation consent process “so that more families are prepared.” 

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