Brain Life and Brain Death - The Anencephalic as an Explanatory Example. A Contribution to Transplantation

Abstract

The current debate regarding the suitability of anencephalics as organ donors is due primarily to misunderstandings. The anatomical and neurophysiological literature shows that the anencephalic lacks a cerebrum because of the failure of neuralplate fusion. However, even the incomplete function of an atrophic brain stem is currently accepted at law in most if not all countries as sufficient for brain life: which is to say, cessation of breathing is currently required in order to make the diagnosis of brain death. Because of the extensive incompleteness of the anencephalic's brain, it is not possible to postpone death significantly by mechanical ventilation and intravenous feeding. It is acceptable to maintain life for a short period of time in order to allow organ transplantation subsequent to the declaration of death at the point of cessation of the capacity for spontaneous respiration. The most important issue is not transplantation, but the issue of brain life raised by the case of anencephalics. Since brain life in any significant sense begins only after the closure of the neural tube on the 30th day after conception, it is reasonable to take this as the point at which brain life begins. Laws should be amended in all countries to allow the abortion of anencephalics at any time, in that they do not at any time possess brain life.

Beginning of Human Life: Doubts and Controversies

“…79 On the other hand Sass 81 accurately pointed out the fact that fusion is not established anatomically without neurons which form synapses, which would be at approximately 70 days (8 weeks) pc. 80 From this perspective, one could look into another example such as the definition of birth which was, some years ago, specified as "the complete expulsion of a fetus of 1000 g or 28 weeks of pregnancy". However, some years later, advancements of perinatal and NICUs (neonatal intensive care units), shifted the line at 500 g or nearly at 22 weeks of gestation.…”

Potential of neonatal organ donation and outcome after transplantation

“…Of the remaining 52 eligible articles not included, the majority ( n = 26) discussed anencephalic neonatal organ donation as either case reports or discussions of ethical aspects 7,16–40 . Utilization of neonatal anencephalic DBD donors ceased in the early 1990s after a study at Loma Linda University Children's Hospital found that anencephalic patients seldom, if ever, met DNC criteria 7 .…”