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Neurological Sciences : Official... Sep 2021One of the first attempts to define brain death (BD) dates from 1963, and since then, the diagnosis criteria of that entity have evolved. In spite of the publication of... (Review)
Review
One of the first attempts to define brain death (BD) dates from 1963, and since then, the diagnosis criteria of that entity have evolved. In spite of the publication of practice parameters and evidence-based guidelines, BD is still causing concern and controversies in the society. The difficulties in determining brain death and making it understood by family members not only endorse futile therapies and increase health care costs, but also hinder the organ transplantation process. This review aims to give an overview about the definition of BD, causes, physiopathology, diagnosis criteria, and management of the potential brain-dead donor. It is important to note that the BD determination criteria detailed here follow the AAN's recommendations, but the standard practice for BD diagnosis varies from one country to another.
Topics: Brain Death; Family; Humans; Tissue Donors; Tissue and Organ Procurement
PubMed: 34138388
DOI: 10.1007/s10072-021-05360-6 -
Canadian Journal of Anaesthesia =... Apr 2023This 2023 Clinical Practice Guideline provides the biomedical definition of death based on permanent cessation of brain function that applies to all persons, as well as...
This 2023 Clinical Practice Guideline provides the biomedical definition of death based on permanent cessation of brain function that applies to all persons, as well as recommendations for death determination by circulatory criteria for potential organ donors and death determination by neurologic criteria for all mechanically ventilated patients regardless of organ donation potential. This Guideline is endorsed by the Canadian Critical Care Society, the Canadian Medical Association, the Canadian Association of Critical Care Nurses, Canadian Anesthesiologists' Society, the Canadian Neurological Sciences Federation (representing the Canadian Neurological Society, Canadian Neurosurgical Society, Canadian Society of Clinical Neurophysiologists, Canadian Association of Child Neurology, Canadian Society of Neuroradiology, and Canadian Stroke Consortium), Canadian Blood Services, the Canadian Donation and Transplantation Research Program, the Canadian Association of Emergency Physicians, the Nurse Practitioners Association of Canada, and the Canadian Cardiovascular Critical Care Society.
Topics: Child; Humans; Canada; Tissue Donors; Tissue and Organ Procurement; Brain; Physicians; Death; Brain Death
PubMed: 37131020
DOI: 10.1007/s12630-023-02431-4 -
Indian Journal of Medical Ethics 2018How do we die? Is it an event or a process? Does everyone die in the same way or are there different ways of dying? Even with humankind's claims to gigantic strides in...
How do we die? Is it an event or a process? Does everyone die in the same way or are there different ways of dying? Even with humankind's claims to gigantic strides in knowledge, death still remains one of the great mysteries for the living. And that makes it the subject of profound and perennial philosophical and religious enquiry. Modern medical science, however, had no option but to engage with it in its bodily form and try to define the precise nature of the process of death. Things were rather easy when death was equal to stoppage of the heart. But inevitably, the world of medicine with its keen sense of observation and constant yearning for scientific reasoning, recognised, somewhere in the middle of the last century, that the brains of a set of individuals hooked onto support systems in intensive care units were dying first, inevitably followed by the heart after some time. The tremendous progress in the science of resuscitation, organ support and intensive care while saving many lives resulted in an increasing number of such individuals, who were soon termed "brain dead" but whose hearts were still beating. The damage to the brain was irreversible and complete and inevitably, the heart had to follow within hours, or sometimes days.
Topics: Brain; Brain Death; Critical Care; Death; Ethics, Medical; Heart; Humans; Intensive Care Units; Resuscitation
PubMed: 30683636
DOI: 10.20529/IJME.2018.081 -
Neurology India 2018Until six decades ago, death was considered to be a specific point in time, referring to the moment at which life ends. With the availability of ventilators, even...
Until six decades ago, death was considered to be a specific point in time, referring to the moment at which life ends. With the availability of ventilators, even determining when death has occurred is becoming difficult, as cessation of life functions is often not simultaneous across organ systems. With increasing accessibility to intensive care units (ICUs) even in Tier II and Tier III cities, and the government making it mandatory to notify brain death to facilitate cadaveric organ transplants, it behooves the neurosurgeon and neurologist to totally understand the minutiae of brain death. The author reflects on his personal experience in certifying brain death, over two decades, in a quaternary care hospital. Knowing the pathophysiology of brain stem dysfunction will help the clinician better understand the rationale of the mandatory clinical tests prescribed. The necessity for an early diagnosis and the pitfalls in the clinical diagnosis of brain death, the limitations of the so-called confirmatory tests, and the concerns and ethical issues will be highlighted. Review of the world literature demonstrates that there is no international consensus even on what constitutes brain death. An individual could be considered legally dead in one country but not in another!
Topics: Brain Death; History, 20th Century; Humans; India; Intensive Care Units
PubMed: 29547144
DOI: 10.4103/0028-3886.227287 -
Journal of Bioethical Inquiry Sep 2023A "universalist" policy on brain death holds that brain death is death, and neurologic criteria for death determination are rightly applied to all, without exemptions or...
A "universalist" policy on brain death holds that brain death is death, and neurologic criteria for death determination are rightly applied to all, without exemptions or opt outs. This essay argues that advocates of a universalist brain death policy defend the same sort of coercive control of end-of-life decision-making as "pro-life" advocates seek to achieve for reproductive decision-making, and both are grounded in an illiberal political philosophy. Those who recognize the serious flaws of this kind of public policy with respect to abortion must apply the same logic to brain death.
Topics: Pregnancy; Female; Humans; Brain Death; Coercion; Abortion, Induced; Reproduction; Philosophy
PubMed: 37380827
DOI: 10.1007/s11673-023-10268-1 -
The Journal of Thoracic and... Apr 2020
Topics: Brain Death; Heart Transplantation; Humans; Registries; Tissue Donors
PubMed: 31221423
DOI: 10.1016/j.jtcvs.2019.04.104 -
Theoretical Medicine and Bioethics Oct 2019The dead donor rule holds that removing organs from living human beings without their consent is wrongful killing. The rule still prevails in most countries, and I...
The dead donor rule holds that removing organs from living human beings without their consent is wrongful killing. The rule still prevails in most countries, and I assume it without argument in order to pose the question: is it possible to have a metaphysically correct, clinically relevant analysis of human death that makes organ donation ethically permissible? I argue that the two dominant criteria of death-brain death and circulatory death-are both empirically and metaphysically inadequate as definitions of human death and therefore hold no epistemic value in themselves. I first set out a neo-Aristotelian theory of death as separation of soul (understood as organising principle) and body, which is then fleshed out as loss of organismic integrity. The brain and circulatory criteria are shown to have severe weaknesses as physiological manifestations of loss of integrity. Given the mismatch between what death is, metaphysically speaking, and the dominant criteria accepted by clinicians and philosophers, it turns out that only actual bodily decomposition is a sure sign of death. In this I differ from Alan Shewmon, whose important work I discuss in detail.
Topics: Brain Death; Ethics, Medical; Humans; Tissue and Organ Procurement
PubMed: 30945062
DOI: 10.1007/s11017-019-09479-8 -
The Yale Journal of Biology and Medicine Dec 2019The diagnosis of brain death (BD) is legally and medically accepted. Recently, several high-profile cases have led to discussions regarding the integrity of current... (Review)
Review
The diagnosis of brain death (BD) is legally and medically accepted. Recently, several high-profile cases have led to discussions regarding the integrity of current criteria, and many physiologic problems have been identified to support the necessity for their reevaluation. These include a global variability of the criteria, the suggestion of a clinical "hierarchy," and the resultant approximation of BD. Further ambiguity has been exposed through case reports of reversible BD, and an inconsistent understanding from physicians who are viewed as experts in this domain. Meeting BD criteria clearly does not equate to a physiologic "death" of the brain, and a greater community perspective should be considered as the dialogue moves forward.
Topics: Brain Death; Guidelines as Topic; Humans; Physicians; Public Opinion
PubMed: 31866791
DOI: No ID Found -
American Journal of Transplantation :... Aug 2019
Topics: Brain Death; Death; Decision Making; Humans; Organ Transplantation; Tissue Donors; Tissue and Organ Procurement
PubMed: 31343845
DOI: 10.1111/ajt.15510 -
Current Opinion in Organ Transplantation Jun 2019The current review presents a concise update on published literature on donation after circulatory death (DCD) and lung transplantation (LTx). Worldwide an increasing... (Review)
Review
PURPOSE OF REVIEW
The current review presents a concise update on published literature on donation after circulatory death (DCD) and lung transplantation (LTx). Worldwide an increasing need for lungs is evident, however the utilization rate of DCD lung donors is still considerably low. In this summary article, we reviewed both the experimental background and international clinical experience.
RECENT FINDINGS
Our analysis confirmed satisfactory results for LTx from DCD donors, which equals the results from donation after brain death. Although most studies reported on short-term results, some confirmed these results on the long-term and development of chronic lung allograft dysfunction. Our review summarizes the different DCD categories and underlines the potential of the DCD V category. We analyze the barriers to implement a DCD program, discuss the more recent advances like ex-vivo lung perfusion and describe the future challenges.
SUMMARY
Based on the current short-term and long-term clinical results, we believe that barriers for DCD utilization should be overcome, resulting in a safe implementation of more DCD LTx programs worldwide. VIDEO ABSTRACT.
Topics: Brain Death; Humans; Lung Transplantation; Middle Aged; Tissue Donors; Tissue and Organ Procurement
PubMed: 31090638
DOI: 10.1097/MOT.0000000000000627