Sonam Tamang declared ‘Brain Dead’

A medical report by the Fukuoka Higashi Medical Center of 10th January 2020 has confirmed that Sonam Tamang, 28, has suffered from ‘Brain Death.’

However, it is not true that Sonam Tamang has ‘lost her life a few days ago,’ as claimed in a Facebook Post that went viral as Sonam is still being kept ‘alive’ by a machine, but her current state is also complicated.

The Prime Minister Lyonchhen (Dr) Lotay Tshering, who received the report, personally briefed Dhan Maya Tamang (mother) and Yanas Tamang (younger brother) on Sonam’s medical status a few days ago with its full range of implications.

The Bhutanese was aware of Sonam’s ‘Brain Dead’ status earlier, but the paper did not publish it until the mother Dhan Maya Tamang received the news from official sources. The fear was that any such publication might cause undue mental stress on the mother, who was in delicate health herself at the time, and so the paper decided to delay the publication of this news until the mother found out first.

However, once all the family members including the mother were aware, the paper then approached the family and sought the willing and explicit consent of Sonam Tamang’s Mother, Father and Brother to publish the information in this article, and they agreed so that the public, which has been following and supporting this case -may also know.

The family also shared the information to ensure that there is no miscommunication on Sonam’s status.

The test confirmed that there was no kind of movement or seizures; it confirmed deep coma; the most essential brainstem reflexes were all absent; the important EEG was flat; there was no auditory brainstem response and spontaneous breathing was absent.

The two doctors, Dr Eri Tanaka and Dr Hiroshi Nakane based on the above medical diagnosis concluded ‘Brain Death,’ and affixed their seals on the report at 4.45 pm on 10th January.

The commonly accepted medical definition of brain death, as also mentioned in an article ‘The diagnosis of brain death’ by Ajay Kumar Goila and Mridula Pawar is ‘the irreversible loss of all functions of the brain, including the brainstem. These include coma, absence of brainstem reflexes, and apnoea. A patient determined to be brain dead is legally and clinically dead.’

The Neurocritical Society Publishing in the University of Yale says, ‘If the clinician has any doubt as to whether there can be even minimal recovery, brain death is not declared. A determination of brain death means that the patient has died; brain death is irreversible.’

It also says, “In the case of brain death, the brain no longer functions, meaning that the patient has suffered injuries so severe that they cannot possibly recover. The patient has passed away. And yet the patient might appear to be sleeping because he or she seems to be breathing and still has a beating heart. We can see how this can be misleading to anyone viewing the body. The breathing appearance comes from the ventilator (breathing machine), and this allows the heart to keep beating. As soon as the machine is disconnected, breathing and the heart beating will stop. It can be hard for families to grasp the finality of their loved one’s death in the wake of these conditions.”

In layman’s terms ‘brain death’ essentially means that there is no chance that a person can recover and is essentially being kept ‘alive’ by the machine or a ventilator in this case. It is also different from a coma or a vegetative state as some key parts of the brain are still functional in those cases which some chances of recovery, which is not there in the case of ‘brain death’.

Japan’s medico-legal system recognizes ‘brain death,’ and it requires a range of tests to be carried out by two physicians to confirm it, which was done in the case of Sonam Tamang.

Dhan Maya, in an interview with the paper said, “Lyonchhen said as per the medical report from Japan my daughter will not be able to recover and that I may have to bring back her dead body.”

She said the PM also said that the Japanese medical insurance of Sonam Tamang that was covering most of the costs may also no longer be paid after this evaluation.

She said, the PM told her, that given the diagnosis, it may not be even possible to bring Sonam back in her current state and keep her here in the Thimphu hospital.

However, whatever the medical definitions, Dhan Maya, though shocked with the news, has not been able to accept the full range of implications that comes with such a diagnosis.

In tears, Dhan Maya said, “When I was there in Japan, my daughter was being fed through a tube and she was even passing urine and stool, so I don’t know how my daughter can be in this condition.”

She said the Prime Minister informed her that he would have a meeting with other ministers and officials on the way forward, and then contact her once they have come up with a decision.

She said her wish was that if Sonam could be brought back to Bhutan so that she can take care of her.

The brain death of Sonam Tamang now presents a complicated situation for the government. Internationally, ‘brain death’ of the above nature is considered as ‘legal death’ and Japan and many other countries even permit organ transplant from such patients with either the prior consent of the patient or family members.

On the other hand, there are major ethical issues for a ‘Buddhist Bhutan,’ which is not as familiar with such cases.

There is also the issue of tremendous public support for Sonam Tamang and the position of the family which places the government in a complicated position.

Both Dhan Maya and her son Yanas Tamang said they are grateful for the support from the public and the government and are awaiting to see what the government will say.

Sonam went to Japan in October, 2017 under controversial ‘Learn and Earn Program’ (LEP) and in September 2018 she fell sick and went into coma. From September 2018, her life completely depended on a life-supporting or ventilation machine at an Intensive Care Unit in Japan.

She had TB first which was complicated by Meningitis. Her situation was aggravated by working under harsh conditions in a factory in Japan.

Her situation, first reported by this paper in July 2019, evoked tremendous public sympathy for her and her mother with around Nu 2.3 mn coming in donations from Bhutanese in Bhutan and all over the world. At the time there was no ‘brain death’ prognosis as attempts were being made to resuscitate her and a test had not yet been done.

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