Prolonged Somatic Survival of Clinically Brain-Dead Adult Patient -Case Report-

Abstract

A 43-year-old woman suffered clinical brain death after severe head injury. The patient met the criteria for the diagnosis of clinical brain death on Day 3. Aggressive hemodynamic and respiratory managements coupled with triple hormone therapy were performed at the family's request, resulting in continued cardiac activity for a prolonged period. Spinal reflexes and automatisms were observed until cardiac arrest. Ventilatory support was discontinued on Day 168, when cardiac death was confirmed, and her kidneys and eyeballs were removed for transplantation. The patient survived for 165 days after the diagnosis of clinical brain death, which is an extremely prolonged period of somatic support for an adult patient after brain death. An extensive and informed discussion on the end-of-life treatment of clinically brain-dead patients is urgently required in Japan to establish treatment guidelines for such patients.

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

“…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). The so-called brain-dead patient shares many features with the living patient.…”

“…Nonetheless, brain-dead patients are in an irreversible coma with apnea and they are dependent on mechanical ventilation (Zamperetti et al, 2004). Patients who have irreversible cessation of higher brain function and brain-stem function or who are brain dead can survive on mechanical ventilation for several days to years (Maruya et al, 2008;Shewmon, 1998). Because these survivors have displayed coordinated physiological functions, including growth to puberty (President's Council on Bioethics, 2007b) and completion of pregnancy and delivery of a live infant (Truog, 2007), they cannot be considered really dead from a biological perspective.…”

Utrzymanie ciąży u ciężarnej z krytycznym uszkodzeniem mózgu

“…This is possible thanks to the advances in intensive therapy whose procedures can shift the borders of somatic inevitable disintegration of the body and delay the development of asystole [5,6]. The longest duration (107 days) of therapy in a pregnant woman diagnosed with brain death completed with the delivery of a new-born (Caesarean section) was reported in 1989 [7].…”

Mechanical Ventilation for Comatose Patients with Inoperative Acute Intracerebral Hemorrhage: Possible Futility of Treatment

“…Among 12 patients who eventually died after being managed with the ventilator, we believe most patients resulted in the undiagnosed brain death during the course of the treatment, but medical care was continued for days. This may result from the special attitude of Japanese to death [22]: life-sustaining of brain-dead patients is not necessarily meaningless for many Japanese people [23], and such an attitude of the patient's family may be seen even in the US [24]. However, the burden on medical resources by prolonging a brain-dead patient's life is so significant and the termination of medical care for brain-dead patients should be socially accepted when establishing the guideline for the medico-social triage, otherwise no medical treatment can be judged as generally “futile”.…”