Brain Death

Joffe, Ari R.; Anton, Natalie

doi:10.1001/archpedi.160.7.747

Cited by 36 publications

(4 citation statements)

References 43 publications

(67 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The strengths of the survey include the development methodology, and unambiguous nature of most of the questions. In addition, the striking similarity of our results to those of other surveys done in the past, including using this same survey in different populations of North American nonneurologist medical specialists, enhances the generalizability of the results [12,13,22-24]. The preponderance of evidence from this survey, and other surveys, support the conclusions we have drawn.…”

Section: Discussionsupporting

confidence: 86%

“…The development and initial testing of the instrument are described in more detail elsewhere [12,13]. The current instrument (Additional File 1) is identical to that used in a survey of Canadian pediatric intensivists and Canadian neurosurgeons, with the following changes: (a) in the first question about acceptable conceptual reasons to explain BD, we added the choice "cessation of the vital work of a living organism--the work of self preservation, achieved through the organism's need driven commerce with the surrounding world" as stated by the President's Council; and (b) we modified the scenario regarding family refusal to stop "life support" in a brain-dead patient to describe continued support for 8 months until ventilator withdrawal, and asked "was this patient dead for the last 8 months?"…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

A survey of American neurologists about brain death: understanding the conceptual basis and diagnostic tests for brain death

et al. 2012

View full text Add to dashboard Cite

BackgroundNeurologists often diagnose brain death (BD) and explain BD to families in the intensive care unit. This study was designed to determine whether neurologists agree with the standard concept of death (irreversible loss of integrative unity of the organism) and understand the state of the brain when BD is diagnosed.MethodsA previously validated survey was mailed to a random sample of 500 board-certified neurologists in the United States. Main outcomes were: responses indicating the concept of death that BD fulfills and the empirical state of the brain that would rule out BD.ResultsAfter the second mailing, 218 (44%) surveys were returned. Few (n = 52, 27%; 95% confidence interval (CI), 21%, 34%) responded that BD is death because the organism has lost integrative unity. The most common justification was a higher brain concept (n = 93, 48%; 95% CI, 41%, 55%), suggesting that irreversible loss of consciousness is death. Contrary to the recent President's Council on Bioethics, few (n = 22, 12%; 95% CI, 8%, 17%) responded that the irreversible lack of vital work of an organism is a concept of death that the BD criterion may satisfy. Many responded that certain brain functions remaining are not compatible with a diagnosis of BD, including EEG activity, evoked potential activity, and hypothalamic neuroendocrine function. Many also responded that brain blood flow and lack of brainstem destruction are not compatible with a diagnosis of BD.ConclusionsAmerican neurologists do not have a consistent rationale for accepting BD as death, nor a clear understanding of diagnostic tests for BD.

show abstract

Section: Discussionsupporting

confidence: 86%

Section: Methodsmentioning

confidence: 99%

A survey of American neurologists about brain death: understanding the conceptual basis and diagnostic tests for brain death

et al. 2012

View full text Add to dashboard Cite

show abstract

“…However, a clinical diagnosis of brain death involves examination of the brain stem only, which is why Joffe et al emphasized that a brain-dead patient does not need to have irreversible loss of the entire brain to be dead [ 28 ]. Indeed, it is known that several encephalic functions may be retained in brain-dead patients [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Revised CT angiography venous score with consideration of infratentorial circulation value for diagnosing brain death

Marchand

Séguin

Malledant

et al. 2016

Ann. Intensive Care

View full text Add to dashboard Cite

BackgroundComputed tomography angiography (CTA) is largely performed in European countries as an ancillary test for diagnosing brain death. However, CTA suffers from a lack of sensitivity, especially in patients who have previously undergone decompressive craniectomy. The aim of this study was to assess the performance of a revised four-point venous CTA score, including non-opacification of the infratentorial venous circulation, for diagnosing brain death.MethodsA preliminary study of 43 control patients with normal CTAs confirmed that the infratentorial superior petrosal vein (SPV) was consistently visible. Therefore, 76 patients (including ten with decompressive craniectomy) who were investigated with 83 CTAs to confirm clinical brain death were consecutively enrolled between July 2011 and July 2013 at a university centre. The image analysis consisted of recording non-opacification of the cortical segment of the middle cerebral artery and internal cerebral vein (ICV), which were used as the reference CTA score, as well as non-opacification of the SPV. The diagnostic performance of the revised four-point venous CTA score based on the non-opacification of both the ICV and SPV was assessed and compared with that of the reference CTA score.ResultsThe revised four-point venous CTA score showed a sensitivity of 95 % for confirming clinical brain death versus a sensitivity of 88 % with the reference CTA score. Non-opacification of the SPV was observed in 95 % of the patients. In the decompressive craniectomy group, the revised four-point CTA score showed a sensitivity of 100 % compared with a sensitivity of 80 % using the reference CTA score.ConclusionCompared with the reference CTA score, the revised four-point venous CTA score based on ICV and SPV non-opacification showed superior diagnostic performance for confirming brain death, including for patients with decompressive craniectomy.

show abstract

“…Second, Ari Joffe and colleagues recently conducted a series of surveys of Canadian paediatric intensivists, 25 Canadian neurosurgeons 26 and US neurologists 27 in an effort to understand their views and knowledge about ‘brain death’. When asked to explain the conceptual rationale for why ‘brain death’ is death, in each study, only a minority selected the loss of integration rationale 9 or loss of the vital work of the organism rationale.…”

Section: What Explains the Mistaken Understanding Of ‘Brain Death’?mentioning

confidence: 99%

Do the ‘brain dead’ merely appear to be alive?

Nair‐Collins

Miller

2017

J Med Ethics

View full text Add to dashboard Cite

The established view regarding ‘brain death’ in medicine and medical ethics is that patients determined to be dead by neurological criteria are dead in terms of a biological conception of death, not a philosophical conception of personhood, a social construction or a legal fiction. Although such individuals show apparent signs of being alive, in reality they are (biologically) dead, though this reality is masked by the intervention of medical technology. In this article, we argue that an appeal to the distinction between appearance and reality fails in defending the view that the ‘brain dead’ are dead. Specifically, this view relies on an inaccurate and overly simplistic account of the role of medical technology in the physiology of a ‘brain dead’ patient. We conclude by offering an explanation of why the conventional view on ‘brain death’, though mistaken, continues to be endorsed in light of its connection to organ transplantation and the dead donor rule.

show abstract

Brain Death

Abstract: There is significant confusion about the concept of BD among pediatric intensivists in Canada. The medical community should reconsider whether BD is equivalent to death.

Cited by 36 publications

References 43 publications

A survey of American neurologists about brain death: understanding the conceptual basis and diagnostic tests for brain death

A survey of American neurologists about brain death: understanding the conceptual basis and diagnostic tests for brain death

Revised CT angiography venous score with consideration of infratentorial circulation value for diagnosing brain death

Do the ‘brain dead’ merely appear to be alive?

Contact Info

Product

Resources

About