Comment: Death is a reality that confronts us all at different times and in different ways. Death of a child, especially your own child, is an ever-present fear. Sadly, every day, somewhere in the world, parents will be confronted by the death of their child in an intensive care unit (ICU). Surrounded by the paraphernalia of high-tech medicine, those who work in the ICU must bring understanding to the family with both sympathy and empathy. Brain death does not seem like death in the same way as cardiac death, and that disconnection between what we know and what we feel is described here with exquisite pain by Ali’s mother.1

van Os first calls for sensitivity from the medical, nursing and other staff in emergency and intensive care departments — clearly spoken here, and indeed spoken before by others. This call has been well heard in Australia and New Zealand, where specific training has been provided to ICU teams for the past 15 years by a program called ADAPT (Australasian Donor Awareness Programme).2 It is not possible to qualify as an intensive care specialist without first completing this training program. The process of gaining permission to proceed to organ donation in Australia should leave none of the uncertainties that crept up unannounced on van Os and her family.1 Our transplant coordinators are trained, and our organ donation agencies have specific bereavement counselling programs to provide care for the donor’s family after organ donation. Emotional doubt over brain death is inescapable, but we try harder here to resolve these concerns than in many places in the world, which may be one reason why our organ donation rates fall behind those in many other countries.

The second call from van Os is to ensure that the community is better informed about the realities of organ donation. Providing appropriate information to the community has been a continual struggle. The expenditure of sufficient advertising money to get these complex messages across has been deemed an unacceptable use of the health dollar. However, there are other ways, and we can always improve our act. The recently created Australian Organ and Tissue Authority is doing just that.3 Ms van Os, your calls have been heard. Somewhere, every minute of every hour of every day, someone dies for lack of the decision that you and your family took — but it was not that day for a teenage girl with heart failure in Thailand.