Brain Death at Fifty: <i>Exploring Consensus, Controversy, and Contexts</i>

Truog, Robert D.; Berlinger, Nancy; Zacharias, Rachel; Solomon, Mildred Z.

doi:10.1002/hast.942

Cited by 23 publications

(27 citation statements)

References 6 publications

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“…As the determination of declaring death depends on cultural and religious perspectives, and has changed over time (Randell 2004 ), a wide variation in the documentation declaring brain death creates confusion among people from different cultures and religions (Busl and Greer 2009 ). This confusion may result from a lack of public understanding of death as a social construct, as it is defined differently by differing personal judgments (Truog et al 2018 ). The social definition of death lacks the conceptual uniformity of the medical determination of brain death (Potter 2017 ; Lamb 1978 ).…”

Section: The Dynamics Of Posthumous Organ Donation Religion and Cultmentioning

confidence: 99%

Deceased Organ Transplantation in Bangladesh: The Dynamics of Bioethics, Religion and Culture

Siraj

2021

HEC Forum

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Organ transplantation from living related donors in Bangladesh first began in October 1982, and became commonplace in 1988. Cornea transplantation from posthumous donors began in 1984 and living related liver and bone marrow donor transplantation began in 2010 and 2014 respectively. The Human Organ Transplantation Act officially came into effect in Bangladesh on 13th April 1999, allowing organ donation from both brain-dead and related living donors for transplantation. Before the legislation, religious leaders issued fatwa, or religious rulings, in favor of organ transplantation. The Act was amended by the Parliament on 8th January, 2018 with the changes coming into effect shortly afterwards on 28th January. However, aside from a few posthumous corneal donations, transplantation of vital organs, such as the kidney, liver, heart, pancreas, and other body parts or organs from deceased donors, has remained absent in Bangladesh. The major question addressed in this article is why the transplantation of vital organs from deceased donors is absent in Bangladesh. In addition to the collection of secondary documents, interviews were conducted with senior transplant physicians, patients and their relatives, and the public, to learn about posthumous organ donation for transplantation. Interviews were also conducted with a medical student and two grief counselors to understand the process of counseling the families and obtaining consent to obtain posthumous cornea donations from brain-dead patients. An interview was conducted with a professional anatomist to understand the processes behind body donation for the purposes of medical study and research. Their narrative reveals that transplant physicians may be reticent to declare brain death as the stipulations of the 1999 act were unclear and vague. This study finds that Bangladeshis have strong family ties and experience anxiety around permitting separating body parts of dead relatives for organ donation for transplantation, or donating the dead body for medical study and research purposes. Posthumous organ donation for transplantation is commonly viewed as a wrong deed from a religious point of view. Religious scholars who have been consulted by the government have approved posthumous organ donation for transplantation on the grounds of necessity to save lives even though violating the human body is generally forbidden in Islam. An assessment of the dynamics of biomedicine, religion and culture leads to the conclusion that barriers to posthumous organ donation for transplantation that are perceived to be religious may actually stem from cultural attitudes. The interplay of faith, belief, religion, social norms, rituals and wider cultural attitudes with biomedicine and posthumous organ donation and transplantation is very complex. Although overcoming the barriers to organ donation for transplantation is challenging, initiation of transplantation of vital organs from deceased donors is necessary within Bangladesh. This will ensure improved healthc...

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Section: The Dynamics Of Posthumous Organ Donation Religion and Cultmentioning

confidence: 99%

Deceased Organ Transplantation in Bangladesh: The Dynamics of Bioethics, Religion and Culture

Siraj

2021

HEC Forum

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“…Conflicts between physicians and families are a part of the public conversation. The case of Ms. Jahi McMath, an example of a family's refusal to accept a brain death diagnosis, caught national attention (Truog et al 2018). The McMath family did not feel heard by their practitioners when their repeated calls to curb Jahi's postsurgical loss of blood were disregarded-neglect believed to have caused her brain death-and the case is emblematic of widespread racial bias in medicine (Goodwin 2018).…”

Section: Discussionmentioning

confidence: 99%

A Pot Ignored Boils On: Sustained Calls for Explicit Consent of Intimate Medical Exams

Bruce

2020

HEC Forum

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Unconsented intimate exams (UIEs) on men and women are known to occur for training purposes and diagnostic reasons, mostly during gynecological surgeries but also during prostate examinations and abdominal surgeries. UIEs most often occur on anesthetized patients but have also been reported on conscious patients. Over the last 30 years, several parties-both within and external to medicine-have increasingly voiced opposition to these exams. Arguments from medical associations, legal scholars, ethicists, nurses, and some physicians have not compelled meaningful institutional change. Opposition is escalating in the form of legislative bans and whistleblower reports. Aspiring to professional and scientific detachment, institutional consent policies make no distinction between intimate exams and exams on any other body part, but patients do not think of their intimate regions in a detached or neutral way and believe intimate exams call for special protections. UIEs are found to contribute to moral erosion and moral distress of medical students and compromise the sacred trust between the medical community and the general public. This paper refutes the main arguments in favor of the status quo, identifies a series of harms related to continuing the current practice, and proposes an explicit consent policy for intimate exams along with specific changes to medical school curriculum and institutional culture. Because patients are the rights-holders of their bodies, consent practices should reflect and uphold patient values which call for explicit consent for intimate exams.

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“…A consensus statement by the World Brain Death Project in August of 2020 contains recommendations for the minimum criteria that must be met to diagnose brain death in both adult and pediatric patients (2,19,38). Current controversies center on whether brain death can be equated with biological death, as well as whether its means of determination accurately measures irreversible loss of function of the entire brain (7,28,(39)(40)(41)(42).…”

Section: Controversies In Brain Death Determinationmentioning

confidence: 99%

Pediatric brain death certification: a narrative review

Fainberg¹,

Mataya²,

Kirschen³

et al. 2021

Transl Pediatr

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In the five decades since its inception, brain death has become an accepted medical and legal concept throughout most of the world. There was initial reluctance to apply brain death criteria to children as they are believed more likely to regain neurologic function following injury. In spite of early trepidation, criteria for pediatric brain death certification were first proposed in 1987 by a multidisciplinary committee comprised of experts in the medical and legal communities. Protocols have since been developed to standardize brain death determination, but there remains substantial variability in practice throughout the world. In addition, brain death remains a topic of considerable ethical, philosophical, and legal controversy, and is often misrepresented in the media. In the present article, we discuss the history of brain death and the guidelines for its determination. We provide an overview of past and present challenges to its concept and diagnosis from biophilosophical, ethical and legal perspectives, and highlight differences between adult and pediatric brain death determination. We conclude by anticipating future directions for brain death as related to the emergence of new technologies. It is our position that providers should endorse the criteria for brain death diagnosis in children as proposed by the Society of Critical Care Medicine (SCCM), American Academy of Pediatrics (AAP), and Child Neurology Society (CNS), in order to prevent controversy and subjectivity surrounding what constitutes life versus death.

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Brain Death at Fifty: Exploring Consensus, Controversy, and Contexts

Cited by 23 publications

References 6 publications

Deceased Organ Transplantation in Bangladesh: The Dynamics of Bioethics, Religion and Culture

Deceased Organ Transplantation in Bangladesh: The Dynamics of Bioethics, Religion and Culture

A Pot Ignored Boils On: Sustained Calls for Explicit Consent of Intimate Medical Exams

Pediatric brain death certification: a narrative review

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