‘Brain death’: should it be reconsidered?

Abstract

Objective: To evaluate whether current clinical criteria and confirmatory tests for the diagnosis of 'brain death' satisfy the requirements for the irreversible cessation of all functions of the entire brain including the brainstem. Data sources: Medical, philosophical and legal literature on the subject of 'brain death'. Data extraction/synthesis: We present four arguments to support the view that patients who meet the current operational criteria of 'brain death' do not necessarily have the irreversible loss of all brain (or brainstem) functions. First, many clinically 'brain-dead' patients maintain residual vegetative functions that are mediated or coordinated by the brain or the brainstem. Second, it is impossible to test for any cerebral function by clinical bedside exam, because the tracts of passage to and from the cerebrum through the brainstem are destroyed or nonfunctional. Furthermore, since there are limitations of clinical assessment of internal awareness in patients who otherwise lack the motor function to show their awareness, the diagnosis of 'brain death' is based on an unproved hypothesis. Third, many patients maintain several stereotyped movements (the so-called complex spinal cord responses and automatisms) which may originate in the brainstem. Fourth, not one of the current confirmatory tests has the necessary positive predictive value for the reliable pronouncement of human death. Conclusion: According to the above arguments, the assumption that all functions of the entire brain (or those of the brainstem) in 'brain-dead' patients have ceased, is invalidated. Reconsideration of the current concept of 'brain death' is perhaps inevitable.

Islam and End-of-Life Practices in Organ Donation for Transplantation: New Questions and Serious Sociocultural Consequences

“…A body of evidence suggests that organ donors who are declared dead either by brain or circulatory criteria may be not really dead but instead may be incipiently dying or destined to die (Joffe, 2007a;Shewmon, 1998;Truog, 2007;Veatch, 2008;Zamperetti, 2004). There is emerging scientific evidence that questions the validity of brain criteria for a declaration of biological or somatic death for the purpose of procuring vital and nonvital organs in HBOD (Karakatsanis, 2008;Truog, 2007;Zamperetti, 2004). The irreversible cessation of higher brain and brain-stem functions is not synonymous in human beings with the loss of somatic integrative unity or with the cessation of coordinated biological functions characteristic of living organisms (Joffe, 2007b;Maruya et al, 2008).…”

Brain death and the cervical spinal cord: a confounding factor for the clinical examination

“…It is interesting that this point is similar to the one made regarding the fact that brainstem damage is a confounding factor for the examination of cerebral functions in patients being assessed for BD. 53 Second, if cervical spinal cord injury cannot be ruled out or is in fact present, another option may be to do an ancillary test to confirm that brainstem function is irreversibly lost. 54 The absence of blood flow to the brainstem would likely show that the brainstem has died, regardless of cervical spinal cord function.…”

La biomedicalización de la muerte: una revisión

“…Se trata entonces de una forma de morir reciente y que está en controversia (Machado, 1994;Karakatsanis, 2008;Russell, 2000) ya que, compartiendo la conclusión que expone Kaufman (2000), aquellos seres que están mantenidos por prácticas médicas modernas o que no están autoregulándose "naturalmente" y no se los considera ni completamente vivos, ni biológicamente muertos, desestabilizan el orden social existente de modos diferentes respecto otras formas híbridas. En esta línea, Bellomo & Zamperetti (2007) abordan en un breve texto las implicaciones de asimilar la muerte encefálica a la muerte ya que no se puede decir cuando una persona está muerta, aunque sí que se puede considerar que es un punto de no retorno que puede guiar las decisiones, las prácticas médicas y las normas legales.…”