Transgender dies : Why did he die?

From The Star,

KUALA TERENGGANU: Mohd Ashraf Hafiz Abdul Aziz, 25, who failed in his bid to change his name to Aleesha Farhana after undergoing a sex change operation in Thailand, has died at the intensive care unit of Hospital Sultanah Nur Zahirah.

Bernama reported that he was admitted to the hospital at 3am on Thursday after experiencing heart problems and low blood pressure and died at 5am on Saturday.

His father Abdul Aziz Ahmad, 60, when contacted, said the family was waiting for family members and relatives to return to Kuala Terengganu and that the funeral would be held after the mid-day prayers Saturday.

Doctors at the hospital on Friday said he was suffering from unstable angina with cardiogenic shock.

Mohd Ashraf Hafiz, 25, had applied to the Kuala Terengganu High Court for an order to change his name and gender but it was rejected on July 18.

A 25 year old who successfully underwent an operation in Thailand, dies of a heart problem. The question is how and why he died? An apparently well person, who even had the strength to fight for his right to change his gender through a futile court process, has died from a heart problem.

Unstable angina with cardiogenic shock?? For those not medically inclined, unstable angina occurs when the heart’s demand for oxygen outstrips its supply due to a narrowing in the arteries supplying the heart. In these circumstances, there may be chest pain. One would not expect cardiogenic shock in unstable angina, unless he has suffered a massive heart attack, which should then be termed myocardial infarction NOT unstable angina. Moreover, there is no history of a heart disease in this gentleman.

One may argue that taking hormonal treatment increases the risk of heart diseases and the incidence of blood clots in the blood vessels. Certainly estrogens increases the risk of blood clots while anti-androgens eg spironolactone can produce hypotension and electrolyte problems. Unfortunately, many of these medications are dispensed without the supervision of a doctor, increasing the risks of complications from careless use of hormonal treatment.

A post mortem should be requested in this case when the death is unexpected. Was it a heart problem that killed him? How bad were his coronary arteries affected? Could another cause explain his sudden death?

Unfortunately in Malaysia, post mortem is often a taboo subject. Many cases go unsolved without a post mortem. The police often do not request one despite odd circumstances surrounding the death, unless pressured to do so. I feel that doctors need to take the lead here in pressuring for a post mortem should a death be unexpected or if foul play is suspected. Family members do not have the right to refuse a post mortem if the cause of death is unknown.

The death certificate and burial permits should be signed by more than one doctor. This will reduce the possibility of a cover-up in certain cases. The second signatory should ideally be one that has no dealings with the case. He/She would act as a neutral party accessing the accuracy of the details surrounding the death and the reasons for it.

It is time to change the way hospitals and the police deals with an unexpected death. Similar to air crash investigations, the reasons should be thoroughly investigated and if mistakes did occur, that it would not happen again.

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