Response to the CBCs the fifth estate on the case of Shane Becker While the Vancouver General Hospital

neurosurgeon is not available for comment, we can share with you the following details of the Shane Becker case that are relevant to the issues you raise regarding declaration of death and the D D process! "he patient charts show the patient was unresponsive when he arrived by ambulance at #$%&' on Sept! (, #))'! He was e*amined by the neurosurgeon at ))%#) +Sept! ,), #))'- in the " scanner in the emergency department! "he neurosurgeon.s recollection is that when he e*amined the patient he noted that the patient.s pupils were fi*ed and dilated, and there were no breathing movements, although the patient was not paraly/ed! "he " scan showed an acute subdural hematoma00a massive brain bleed! 1t was the neurosurgeon.s e*perience that with such a severe in2ury to the brain, no surgical intervention could save the patient.s life! He determined that the patient was not yet brain dead, but that his condition would likely lead to brain death! He recommended the withdrawal of life support! However, at this point, the patient was still intubated and breathing with the assistance of a ventilator! 3t ),%#), an emergency room physician and social worker met with the patient.s family! 3ccording to the patient.s health record, the topic of organ donation was discussed! "he social worker involved in this meeting does not now recall any details of that discussion, other than that the family was supportive of donation! 1t would have been premature4and highly unusual4for staff to have raised any discussion of organ donation at this point, and it ought not to have occurred without clear communication that in order for organ donation to take place, the patient would need to have formally declared brain dead! 3t )#%,&, a bedside assessment by an 1 5 physician noted that the patient.s corneal and gag refle* tests indicated he was not brain dead! 3t )#%6) a further assessment shows signs of improvement in the patient.s condition! "he 1 5 team engaged the neurosurgeon to make a reassessment, following which he conducted surgery on the patient! B "ransplant and V H records have confirmed that no referral was made to the B "ransplant donation team! 7urther review of records shows no record that an 1ntent to 8egister +B "ransplant 9rgan Donor 8egistry- form was signed!

Donation process in 2006 1n B , prior to #)):, organ donation occurred only through ;DD +neurological determination of death-, commonly referred to as brain death!

"his patient did not meet the criteria for ;DD < neurological determination of death, and there was never a possibility that this case could have proceeded to organ donation without the patient having progressed to brain death! However, assuming this patient was e*pected to proceed to brain death, and donation was discussed and agreed to, the process would have proceeded according to ;DD criteria as follows! =atient transfer to 1 5 for management, including testing re>uired for declaration of death according to ;DD criteria! Declaration of neurological death by two physicians < patient remains on the ventilator +life0 support-! 8eferral to B "ransplant organ donation team! "he 9rgan Donor 8egistry is consulted to see if the patient has registered their intent to donate! 1n the absence of this decision, the appropriate family member assumes the role of decision maker, to represent to the best of their knowledge, their loved one.s wishes regarding organ donation! 9rgan donation team meets with family to e*plain process, review and complete consent forms, and obtain medical?social history of patient! 7ollowing consent and med?social history, e*tensive testing +i!e! blood work, chest *0rays, " scan, echocardiogram, and bronchoscopy- is conducted to determine suitability of organs for donation! @edical testing, recipient matching and coordination of surgical times can take #6 < 6: hours! 7amily is given opportunity to say goodbye to their loved one in the 1 5, prior to the patient transfer to the 98! Ventilator removed in the 98 at time of surgical recovery!

Donation process after 2008 1mplementation of D D < donation after cardiac death < began in B in #)):, in accordance with the national guidelines established by the anadian "ransplant ommunity! Had donation after cardiac death been an option in #))' when the patient arrived at the hospital, there is still no possibility his case could have proceeded to organ donation < the time frame, and the testing process involved in D D would have prevented this from happening! 9rgan donation occurs through a process that involves a series of tests and information gathering, done over a period of time! "he process is designed to ensure donation is an appropriate option as part of end of life care! "o be considered for donation, current eligibility criteria re>uire that the patient must have sustained a devastating neurological in2ury from which recovery is impossible! "wo staff physicians determine the patient has no possibility of recovery and a move to comfort care is appropriate! Decision to withdraw life sustaining therapy is 2oint decision between most responsible physician and family! "he family has made the decision to withdraw life support! 3 referral is made to the B "ransplant organ donation team! "he 9rgan Donor 8egistry is consulted to see if the patient has registered their intent to donate! 1n the absence of this decision, the appropriate family member assumes the role of decision maker, to represent to the best of their knowledge, their loved one.s wishes regarding organ donation!

"he B "ransplant organ donation team meets with family to e*plain process, review and complete consent forms, and obtain medical?social history of patient! 7ollowing consent and med?social history, e*tensive testing, +i!e! blood work, chest *0ray " scan and bronchoscopy- is conducted to determine suitability of organs for donation! @edical testing, recipient matching and coordination of surgical times can take #6 < 6: hours! "he e*act timing of removal of the ventilator will be coordinated and agreed upon by the family, B "ransplant, intensive care unit, and the operating room staff! 7amily members can be present when life support is withdrawn! 9nce life sustaining therapy is withdrawn there is a finite time, within which the patient must die, in order for the organs to remain healthy enough to transplant! Death begins at the onset of circulatory arrest < the heart stops beating and there is no pulse! 1f the onset of circulatory arrest does not occur within a short time frame +ranging, on a case by case basis, from minutes to a ma*imum of two hours- it is not possible for the patient to proceed to organ donation! 1f circulatory arrest does occur within this time frame the timing of events is as follows% o "he onset of circulatory arrest, which is determined by two staff physicians, is time /ero! 3t this point the family says farewell and the patient is moved to the 98A o 7or the ne*t five minutes, the two staff physicians continue to observe the patient for any signs of life! 3t the end of the five minute period, the two staff physicians re0 e*amine the patient and at that time the patient is declared dead!

7ortunately, the patient in this case made a recovery! However, then, as now, there are e*tensive processes in place designed to ensure organ donation is appropriate, safe
and respectful!