A reply

Abstract

Thank you for the interest in our study which was prompted by observations that patients potentially suitable for NHBD following out-of-hospital cardiac arrest often took too long to die to be eligible for donation. As with all retrospective studies there are weaknesses in this audit, as outlined in Kupier et al.’s letter. The timeframe in which the audit was conducted overlapped, just, the introduction of NHBD and no patients included in the audit were actually considered for NHBD. Hence the modes of death were as practised at that time. In addition, at that time we had not introduced therapeutic hypothermic techniques for such patients. As can be seen from the editorial which accompanied our article [1] not all clinicians in the UK are ready to endorse the concepts of NHBD. We therefore have to be very careful in how we approach the modes of withdrawal of supportive care, which is performed according to traditional approaches after careful discussion with families and those close to the patient. We feel that honest and open discussion of all issues in relation to NHBD is vital to allow clinicians, patients and their families to understand the process. As a result of such discussions in our region we have seen many doctors, nurses, and families change their views from initial suspicion and hostility to guarded support of the process.