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Ugeskrift For Laeger Jun 2018Death can be pronounced on both circulatory and brain criteria. In both cases, irreversible loss of brain function is essential in understanding finale death, as... (Review)
Review
Death can be pronounced on both circulatory and brain criteria. In both cases, irreversible loss of brain function is essential in understanding finale death, as irreversible loss of breathing - a brainstem function - is mandatory. Brain function ceases irreversibly as a consequence of lack of blood supply to the brain, caused by circulatory arrest or by raised intracranial pressure. Brain function is central in death, which must be reflected in a future death criterion, stated in WHO´s new death criterion based on irreversible loss of capacity for consciousness and loss of brainstem function.
Topics: Brain Death; Brain Stem; Death; Humans
PubMed: 29938638
DOI: No ID Found -
Apnea testing during brain death assessment: a review of clinical practice and published literature.Respiratory Care Mar 2013The diagnosis of brain death is a complex process. Strong knowledge of neurophysiology and an understanding of brain death etiology must be used to confidently determine... (Review)
Review
The diagnosis of brain death is a complex process. Strong knowledge of neurophysiology and an understanding of brain death etiology must be used to confidently determine brain death. The key findings in brain death are unresponsiveness, and absence of brainstem reflexes in the setting of a devastating neurological injury. These findings are coupled with a series of confirmatory tests, and the diagnosis of brain death is established based on consensus recommendations. The drive to breathe in the setting of an intense ventilatory stimulus (ie, respiratory acidosis) is a critical marker of brainstem function. As a consequence, apnea testing is an important component of brain death assessment. This procedure requires close monitoring of a patient as all ventilator support is temporarily removed and Paco2 levels are allowed to rise. A "positive" test is defined by a total absence of respiratory efforts under these conditions. While apnea testing is not new, it still lacks consensus standardization regarding the actual procedure, monitored parameters, and evidence-based safety measures that may be used to prevent complications. The purpose of this report is to provide an overview of apnea testing and discuss issues related to the administration and safety of the procedure.
Topics: Apnea; Brain Death; Humans; Practice Guidelines as Topic
PubMed: 22709413
DOI: 10.4187/respcare.01962 -
Deutsches Arzteblatt International Aug 2016The ascertainment of brain death (the irreversible, total loss of brain function) gives the physician the opportunity to limit or stop further treatment. Alternatively,... (Review)
Review
BACKGROUND
The ascertainment of brain death (the irreversible, total loss of brain function) gives the physician the opportunity to limit or stop further treatment. Alternatively, if the brain-dead individual is an organ donor, the mode of treatment can be changed from patient-centered to donationcentered. Consensus-derived recommendations for the organ-protective treatment of brain-dead organ donors are not yet available in Germany.
METHODS
This review is based on pertinent publications retrieved by a selective search in PubMed, and on the authors' clinical experience.
RESULTS
Brain death causes major pathophysiological changes, including an increase in catecholamine levels and a sudden drop in the concentration of multiple hormones, among them antidiuretic hormone, cortisol, insulin, and triand tetraiodothyronine. These changes affect the function of all organ systems, as well as the hemodynamic state and the regulation of body temperature. The use of standardized donor management protocols might well increase the rate of transplanted organs per donor and improve the quality of the transplanted organs. In addition, the administration of methylprednisolone, desmopressin, and vasopressin could be a useful supplement to treatment in some cases. Randomized controlled trials have not yet demonstrated either improved organ function or prolonged survival of the transplant recipients.
CONCLUSION
The evidence base for organ-protective intensive care is weak; most of the available evidence is on the level of expert opinion. There is good reason to believe, however, that the continuation of intensive care, in the sense of early donor management, can make organ transplantation more successful both by increasing the number of transplantable organs and by improving organ quality.
Topics: Brain Death; Critical Care; Evidence-Based Medicine; Germany; Humans; Patient-Centered Care; Tissue Donors; Tissue and Organ Procurement
PubMed: 27598872
DOI: 10.3238/arztebl.2016.0552 -
Medicina Intensiva May 2009Brain death has been recognized by the scientific community as the person's death, and accepted in the legislation of different countries. Brain death is defined as the... (Review)
Review
Brain death has been recognized by the scientific community as the person's death, and accepted in the legislation of different countries. Brain death is defined as the irreversible ending of the functions of all the intracranial neurological structure in both the brain and brain stem. This clinical situation appears when intracranial pressure exceeds the patient's systolic blood pressure, leading to brain circulatory arrest. The most frequent are cerebral hemorrhage and cranioencephalic trauma. Clinical diagnostic must be done by doctors with expertise in neurocritical patient treatment. This diagnosis is based on a systematic, complete and extremely rigorous clinical examination that confirms a non-reactive coma, absence of brain stem reflex, and absence of spontaneous breathing. Instrumental tests may be obligatory in some cases, this depending on each country. Electroencephalogram and evoked potentials are the electrophysiological tests used. In patients treated with sedative drugs, cerebral blood flow evaluation tests, such as cerebral angiography, transcranial Doppler or 99Tc-HMPAO scintigraphy, will be used. More than 92% of the transplants performed in Spain are performed with brain death donor organs. Brain death confirmation is a high responsibility act, with medical, ethical and legal significance since it requires removal of all artificial support, or organs extraction for transplant. Extensive knowledge on its diagnostic and correct decision making avoid unnecessary use of resources and improves management of organs for transplant.
Topics: Brain Death; Humans; Neurologic Examination
PubMed: 19558940
DOI: 10.1016/s0210-5691(09)71215-x -
Medicina (Kaunas, Lithuania) 2016The prominence of biomedical criteria relying on brain death reduces the impact of metaphysical, anthropological, psychosocial, cultural, religious, and legal aspects... (Review)
Review
The prominence of biomedical criteria relying on brain death reduces the impact of metaphysical, anthropological, psychosocial, cultural, religious, and legal aspects disclosing the real value and essence of human life. The aim of this literature review is to discuss metaphysical and biomedical approaches toward death and their complimentary relationship in the determination of death. A critical appraisal of theoretical and scientific evidence and legal documents supported analytical discourse. In the metaphysical discourse of death, two main questions about what human death is and how to determine the fact of death clearly separate the ontological and epistemological aspects of death. During the 20th century, various understandings of human death distinguished two different approaches toward the human: the human is a subject of activities or a subject of the human being. Extinction of the difference between the entities and the being, emphasized as rational-logical instrumentation, is not sufficient to understand death thoroughly. Biological criteria of death are associated with biological features and irreversible loss of certain cognitive capabilities. Debating on the question "Does a brain death mean death of a human being?" two approaches are considering: the body-centrist and the mind-centrist. By bridging those two alternatives human death appears not only as biomedical, but also as metaphysical phenomenon. It was summarized that a predominance of clinical criteria for determination of death in practice leads to medicalization of death and limits the holistic perspective toward individual's death. Therefore, the balance of metaphysical and biomedical approaches toward death and its determination would decrease the medicalization of the concept of death.
Topics: Biomedical Research; Brain Death; Humans; Knowledge; Metaphysics; Mind-Body Relations, Metaphysical; Tissue and Organ Procurement
PubMed: 27697237
DOI: 10.1016/j.medici.2016.06.002 -
Neurology May 2015To assess the practices and perceptions of brain death determination worldwide and analyze the extent and nature of variations among countries.
OBJECTIVE
To assess the practices and perceptions of brain death determination worldwide and analyze the extent and nature of variations among countries.
METHODS
An electronic survey was distributed globally to physicians with expertise in neurocritical care, neurology, or related disciplines who would encounter patients at risk of brain death.
RESULTS
Most countries (n = 91, response rate 76%) reported a legal provision (n = 63, 70%) and an institutional protocol (n = 70, 77%) for brain death. Institutional protocols were less common in lower-income countries (2/9 of low [22%], 9/18 lower-middle [50%], 22/26 upper-middle [85%], and 37/38 high-income countries [97%], p < 0.001). Countries with an organized transplant network were more likely to have a brain death provision compared with countries without one (53/64 [83%] vs 6/25 [24%], p < 0.001). Among institutions with a formalized brain death protocol, marked variability occurred in requisite examination findings (n = 37, 53% of respondents deviated from the American Academy of Neurology criteria), apnea testing, necessity and type of ancillary testing (most commonly required test: EEG [n = 37, 53%]), time to declaration, number and qualifications of physicians present, and criteria in children (distinct pediatric criteria: n = 38, 56%).
CONCLUSIONS
Substantial differences in perceptions and practices of brain death exist worldwide. The identification of discrepancies, improvement of gaps in medical education, and formalization of protocols in lower-income countries provide first pragmatic steps to reconciling these variations. Whether a harmonized, uniform standard for brain death worldwide can be achieved remains questionable.
Topics: Attitude of Health Personnel; Brain Death; Developed Countries; Developing Countries; Electroencephalography; Hospitals; Humans; Neurologic Examination; Neurology; Organizational Policy; Practice Patterns, Physicians'; Time Factors
PubMed: 25854866
DOI: 10.1212/WNL.0000000000001540 -
Nature Reviews. Neuroscience Nov 2005The concept of death has evolved as technology has progressed. This has forced medicine and society to redefine its ancient cardiorespiratory centred diagnosis to a... (Review)
Review
The concept of death has evolved as technology has progressed. This has forced medicine and society to redefine its ancient cardiorespiratory centred diagnosis to a neurocentric diagnosis of death. The apparent consensus about the definition of death has not yet appeased all controversy. Ethical, moral and religious concerns continue to surface and include a prevailing malaise about possible expansions of the definition of death to encompass the vegetative state or about the feared bias of formulating criteria so as to facilitate organ transplantation.
Topics: Bioethical Issues; Brain; Brain Death; Death; Humans; Persistent Vegetative State; Unconsciousness
PubMed: 16261182
DOI: 10.1038/nrn1789 -
Journal of Religion and Health Aug 2016Brain death is a novel construct of death for the procurement of transplantable organs. Many authoritative Islamic organizations and governments have endorsed brain... (Review)
Review
Brain death is a novel construct of death for the procurement of transplantable organs. Many authoritative Islamic organizations and governments have endorsed brain death as true death for organ donation. Many commentators have reiterated the misconception that the Quranic text does not define death. We respond by clarifying: (1) the Quran does define death as biologic disintegration and clearly distinguishes it from the dying process, (2) brain death belongs scientifically within the spectrum of neurologic disorders of consciousness and should not be confused with death, and (3) religious and legal discord about brain death has grown in jurisdictions worldwide. We urge for public transparency and truthfulness about brain death and the accommodation and respect of religious objection to the determination of death by neurologic criteria.
Topics: Brain Death; Humans; Islam; Religion and Medicine; Tissue and Organ Procurement
PubMed: 27010462
DOI: 10.1007/s10943-016-0221-z -
British Journal of Anaesthesia May 2004
Topics: Brain Death; Clinical Competence; Death; Humans; United Kingdom
PubMed: 15113762
DOI: 10.1093/bja/aeh115 -
Critical Care (London, England) Nov 2020
Topics: Brain Death; Humans; Physical Examination
PubMed: 33208181
DOI: 10.1186/s13054-020-03376-6