Request for Retraction

Abstract

To the Editor We agree with both Auyong et al.1 and Csete2 that the donation after cardiac death (DCD) process should be carefully handled, as well as that there are changes in processed electroencephalogram after the withdrawal of treatment. We do, however, have a concern that these findings might be misinterpreted as showing that donors are not dead before organ retrieval surgery, a concern given additional weight by the emphasis on the DCD process by both Auyong et al. and Csete that distracts from the central theme of best practice in end-of-life care. What has been well demonstrated is a change in bispectral index (BIS) after withdrawal of organ support and before donation after circulatory determination of death3 and not alterations in BIS during organ retrieval surgery. It is reassuring that in each case, BIS values decreased to 0 after death (before any surgical intervention). It would be interesting to see BIS monitoring in patients who had treatment withdrawn but were not proceeding to organ donation. We believe that the emphasis should therefore be placed on the role of good end-of-life care, wherever and whenever treatment is withdrawn. It may be that these findings highlight a need for increased sedative and analgesic use during the dying process in all patients, and it would be a shame if they were misused to argue against the role of DCD in organ procurement. Matt Thomas, MRCP, FRCA, DICM Ian Thomas, MRCP, FRCA, DICM Department of Anaesthesia Frenchay Hospital Bristol, United Kingdom [email protected]