Brain-death diagnosis based on stringent clinical criteria

The Sunday Times reported on the case of Ms Suzanne Chin, who recovered from a coma ("Back from the dead: 'I have been blessed with a second chance'"; Sunday).

We are happy that Ms Chin has made a recovery. However, we are not able to comment on the case as we do not have access to specific information on her medical treatment in Hong Kong and what exactly was diagnosed and communicated to her family.

Brain death is diagnosed only when there is catastrophic brain injury. When brain death has occurred, blood flow and oxygen delivery to the brain ceases irreversibly and all brain functions are lost and will never return again.

Brain death is determined according to strict clinical criteria.

Once diagnosed, it is recognised both medically and legally in Singapore as death of the person.

This definition is similar to those used in countries such as Australia, Canada, Denmark, Britain and the United States.

Brain death implies the irreversible cessation of consciousness, loss of capacity to breathe and other brain stem functions, and is accepted as the termination of a human's life; correspondingly, the diagnosis of brain death is very important.

The neurological criteria for diagnosing brain death in Singapore are based on current best medical evidence and knowledge, and are similar to those adopted by countries such as the US, Australia, and Britain.

In Singapore, all criteria have to be fully met for the diagnosis of brain death, including absence of pupillary response to light, absence of corneal reflex and absence of respiratory drive or spontaneous breathing, to cite a few; and when one or more of these tests cannot be done, additional tests to demonstrate the absence of brain circulation need to be performed.

In addition, two doctors are required to certify brain death, at least one of whom has to be independent and not involved in the care of the patient.

Doctors accredited to perform brain-death certification in our hospitals are specialists who have had appropriate training to certify brain death.

We would like to reassure the public of the highest standard of medical practice in our hospitals, and that correctly diagnosed brain death is not a reversible medical condition.

Kwek Tong Kiat (Clinical Associate Professor)
Senior Consultant,
Ministry of Health, Hospital Services Division
Head and Senior Consultant
Dept of Anaesthesiology, Intensive Care and Pain Medicine
Tan Tock Seng Hospital

Lee Heow Yong (Dr)
Acting Director/Hospital Services Division, Health Services Group
Ministry of Health

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