There are no national criteria for declaring brain death, but California law requires that two physicians independently verify the condition and that those physicians not have any role in procuring the patient's organs. Organs cannot be retrieved until a patient is declared legally dead.
Foster, an auto mechanic, collapsed Feb. 18 and was diagnosed with an inoperable Pontine bleed, a catastrophic hemorrhage in his brain stem with almost no hope of recovery.
Hours later, hospital personnel alerted the California Transplant Donor Network -- the organ procurement group for much of Central and Northern California -- that he was a potential candidate for organ donation. Such notification is routine.
After Sanchez agreed to donate, she said, she got calls "at least twice a day" from the organ group, saying: "We have to get the body parts in a certain time. Your dad can be a life-saver to someone else. How is he doing today? Did he go up or down?"
In the afternoon of Feb. 21, it seemed the end had arrived for Foster. First, one doctor declared him brain-dead, according to confidential internal records kept by the organ group and reviewed by The Times.
Then, a couple hours later, a second doctor, an emergency physician, shined a light on his pupils and agreed. With two such declarations, Foster was legally dead under California law.
Sanchez said she was concerned because the second doctor seemed in a rush.
3rd opinion sought
After the exam, Sanchez recalled, "he just came in and threw the paper on my dad's legs and said, 'We got two signatures. We're pulling the plug,' He said, 'That's hospital policy.' "
She said she demanded a third opinion.
About the same time, a nursing supervisor asked the family to leave the room and did her own examination, the organ group's records show. Foster displayed a strong gag and cough reflex and slightly moved his head, all inconsistent with brain death. She shared her concerns with physicians.
The third doctor, neurosurgeon Mukesh Misra, determined that Foster was not brain-dead and supported Sanchez's decision not to remove her father from life support, records show.
Misra declined to comment on his colleagues' actions, but said, "I know what I did was right."
Dr. Robert Grazier, the second physician who declared Foster brain-dead, acknowledged that he performed a brief examination. "I examined the patient and I confirmed the first doctor's findings that were recorded. That was about it," Grazier said.
