How to respond to an outrageous article?

Point-by-point, with kindness, though there is such a thing as righteous anger. The editors of the Wall Street Journal should not have published this.

On Behalf of Rebecca Dodd- Sullivan, RN, CPTC, Senior Organ Procurement Coordinator - CA. This article is fundamentally flawed in accuracy and it's recent publication severely discredits the WSJ. Mr Teresi states that "current" criteria for brain death, or death by neurologic criteria, were set by a Harvard Medical School commmittee in 1968, failing to also state that The Quality Standards Subcommittee of the American Academy of Neurology published a landmark paper in 1995, and then an update in 2010, delineating clear and updated practice parameters for determing brain death. These reports outline diagnostic criteria for the clinical diagnosis of brain death and are meant to set the medical standards for the determination of death. They are not "simple" as Mr Teresi ineptly states in paragraph 6 of his unfortunate article. Every neurosciences physician in the US who has ever taken the time to carefully assess a patient for the clinical diagnosis of brain death, and then wrote a careful note explaining his findings, should be outraged by Mr Teresi's misleading comments. Additionally, Mr Teresi has a penchant for citing old and poorly referenced materials in this article. He states that Gail A. Van Norman's article from a "peer reviewed" medical jounal, embarrassingly published in the journal "Anesthesiology" in 1999, is proof that a 30 yo patient was "breathing" at time of organ procurement. If you look at her article, Van Norman's own words state the following: " During an educational course for anesthesiologists, a participant described a case, not independantly verified by the author (Van Norman) in which a 30 yr old patient was admitted to a level 1 trauma center......" and then goes on to say that the anesthesiologist noted that the patient was "breathing" at the time of procurement. So, this Van Norman has taken an unverified, second hand report that the patient was spontaneously breathing while intubated and on a ventilator. I am not sure that I would feel as comfortable as Mr Teresi in citing work by a physician with such shoddy data reporting abilities. And, if the patient were actually exhibiting "breaths" on the ventilator, did this "second hand" source anesthesiologist assess for the confusing phenomenon of ventilator auto-triggering, which is caused by supersensitve ventilators which register the transpleural pressure changes of the hyperdynamic brain dead heart, as patient mediated respiratory effort and subsequently delivers ventilator mediated breaths which are often augmented in size by the addition of pressure support dialed in on the ventilator settings? There are MANY reports in the literature of ventilator autotriggering and why it occurs in a brain dead patient. To this end, the properly administered apnea test is the gold standard for assessing spontaneous respiratory effort. It is also interesting that the same author, Van Norman, who is so oft cited by Mr Teresi as an expert, implicitly states in the same 1999 article that an EEG is no longer a reliable test in the assessment of brain function. Mr Teresi for some reason is still advising his readers to ask for this test to be administered in brain death assessments. Why is Mr Teresi picking and choosing information from this already dubious and outdated source article? Clearly it's to write a muck-raking piece meant to confuse the lay public and sell more of his books full of fallacies. These are just a few easily spotted tidbits of misleading rubbish put forth by Mr Teresi. My sincere hope is that the WSJ endeavors to do the real research required to check Mr Teresi's assertions, then issues a retraction followed by an apology for misleading the public sector. If not, the WSJ is at risk for losing all future credibility. Rebecca Dodd- Sullivan, RN, CPTC, Senior Organ Procurement Coordinator - CA.

thanks for the clarification about the context of these comments. It reinforces the premise that there is no such thing as bad publicity. The WSJ is on a bit of a roll: last month they had an article by the former FDA Commissioner who suggested that FDA approval of new drugs be based on safety alone with demonstration of efficacy to come later. http://online.wsj.com/article/SB1000142405297020364600457721540339935087... Of course, that would toss the concept of risk: benefit out the window and I can only imagine how that would play out in the today's economic climate.

http://www.npr.org/player/v2/mediaPlayer.html?action=1&t=1&islist=false&... Dr. Friedman did an excellent job at explaining the process of organ donation and organ procurement on NPR. Link attached Alexander Aussi San Diego, CA