In a recent survey by another tertiary care hospital in Karachi, it was noticed that there are confusions in the definition of brain death, end-of-life recognition and indications and processes of
withdrawal of life support and discrepancies were found for perceptions and attitudes between physicians and nurses.
For instance, if further medical care would be futile, meaning that the person's medical prognosis will never improve to allow him or her to be able to function without life support, the person does not wish to live continuously in this state, and
withdrawal of life support is planned, then a person can be deemed legally dead, despite not technically meeting the "irreversible" component of the UDDA.
The rate of
withdrawal of life support in our study was only 4%, which is similar to the rates that have been observed in India (9), Lebanon (2) and Turkey (15).
(38.) Meeker, "Family Surrogate Decision Making at the End of Life"; Mayer and Kossoff, "
Withdrawal of Life Support in the Neurological Intensive Care Unit"; Prendergast and Puntillo, "
Withdrawal of Life Support."
But no mention of donation is made until
withdrawal of life support has been discussed with the family.
They found that at least 25,000 cases annually consisted of the
withdrawal of life support (passive euthanasia), and of those, 27% were administered morphine in order to shorten life.
"When the
withdrawal of life support is consensually decided by the attending physician and the family member or surrogate (particularly in the hospital setting of the ICU), consistent opportunity for DCD should now be available to all families or to honor the deceased donor's wishes." -- The Draft Report of a National Conference on Donation After Cardiac Death
Decisions regarding the
withdrawal of life support in desperately ill patients are always difficult, often heart-wrenching.
The decision to declare the patient 'suitable' to donate organs would be made either after, or even before, the
withdrawal of life support (ventilation).
Because of the physical and mental traumas many of these children have faced, it is not unusual for the decisions to involve major surgery, orders not to resuscitate, or even
withdrawal of life support.