Brain-dead Patients Research Articles

The role of optic nerve sheath diameter measurement in the diagnosis of brain death.

The aim of this study is to evaluate the correlation between optic nerve sheath diameter (ONSD) measured using computed tomography (CT), and ONSD measured using bedside ultrasonography (USG) in the diagnosis of brain death. A total of 21 brain-dead patients were included in the study. The ONSD values of these patients were measured using both USG and CT before and after brain death, and the relationship between these measurements was evaluated. There was a high level of correlation between the right-left eye ONSD measurements conducted before brain death using USG and CT, respectively (p=0.000, p=0.001). There was a high level of correlation between the right-left eye ONSD measurements conducted after brain death using USG and CT, respectively (p=0.000, p=0.00). Pre-brain death ONSD mean values of both left and right eyes, measured using USG and CT, were found to be statistically significantly lower than the mean values of post-brain death measurements. In conclusion, a statistically significant difference was found between the optic nerve sheath diameter values measured before and after brain death using USG and CT. At the same time, it was determined that the values of the optic nerve sheath diameter measured using both CT and USG were correlated.

Multidimensional assessment of heartbeat-evoked responses in disorders of consciousness.

Because consciousness does not necessarily translate into overt behaviour, detecting residual consciousness in noncommunicating patients remains a challenge. Bedside diagnostic methods based on EEG are promising and cost-effective alternatives to detect residual consciousness. Recent evidence showed that the cortical activations triggered by each heartbeat, namely, heartbeat-evoked responses (HERs), can detect through machine learning the presence of minimal consciousness and distinguish between overt and covert minimal consciousness. In this study, we explore different markers to characterize HERs to investigate whether different dimensions of the neural responses to heartbeats provide complementary information that is not typically found under standard event-related potential analyses. We evaluated HERs and EEG average non-locked to heartbeats in six types of participants: healthy state, locked-in syndrome, minimally conscious state, vegetative state/unresponsive wakefulness syndrome, comatose and brain-dead patients. We computed a series of markers from HERs that can generally separate the unconscious from the conscious. Our findings indicate that HER variance and HER frontal segregation tend to be higher in the presence of consciousness. These indices, when combined with heart rate variability, have the potential to enhance the differentiation between different levels of awareness. We propose that a multidimensional evaluation of brain-heart interactions could be included in a battery of tests to characterize disorders of consciousness. Our results may motivate further exploration of markers in brain-heart communication for the detection of consciousness at the bedside. The development of diagnostic methods based on brain-heart interactions may be translated into more feasible methods for clinical practice.

Attitudes That Might Impact upon Donation after Brain Death in Intensive Care Unit Settings: A Systematic Review.

Organ donation and transplantation can save or improve the quality of life of people worldwide. However, there are many challenges associated with organ donation, as the demand for organs greatly outstrips supply. Additionally, there are brain-dead patients who could be potential organ donors. It is thus important to determine the attitudes affecting organ donation and transplantation in intensive care unit settings. this study aimed to identify attitudes that might affect organ donation and transplantation in intensive care unit settings. Five electronic databases (CINAHL, Medline, PsycINFO, Scopus, and EMBASE) were searched systematically. A systematic search strategy was formulated. The quality of each study was assessed using the MMAT quality appraisal tool. A total of seven studies were included. The findings of this systematic review demonstrate that education, policy, and continuing professional development could help to address barriers to donation. therefore, to influence organ donation and transplantation positively, the main themes evaluated in this systematic review provide an opportunity to influence organ donation and transplantation attitudes in intensive care unit settings.

Kidneys recovered from brain dead cardiac arrest patients resuscitated with ECPR show similar one-year graft survival compared to other donors

IntroductionAmong patients treated with extracorporeal cardiopulmonary resuscitation (ECPR) as a second line of treatment for refractory out-of-hospital cardiac arrest (OHCA), some may develop brain death and become eligible for organ donation. The objective of this study was to evaluate long-term outcomes of kidney grafts recovered from these patients. Material and methodsWe conducted a retrospective monocentric observational study between January 1, 2011, and December 31, 2017. We exclusively included patients eligible for planned donation after brainstem death and from whom at least one organ graft was retrieved and transplanted. We compared two groups of brain dead patients: those treated with ECPR for refractory OHCA (ECPR group) and a diverse group of patients who did not receive ECPR, from which only 5/23 (22%) had OHCA (control group). The primary outcome was one-year kidney graft survival. ResultsWe included 45 patients, 23 in the control group and 22 in the ECPR group. Although patients in the ECPR group were younger and had a lower prevalence of chronic renal disease (p = 0.01), their kidney function was more severely impaired upon admission in the ICU. A total of 68 kidney grafts were retrieved, transplanted, and studied, 34 in each study group. There was no significant difference between the two groups in terms of one-year kidney graft survival (p = 0.52). ConclusionOrgan transplantation from patients treated with ECPR after refractory OHCA showed one-year kidney graft survival rates comparable to those of patients not treated with ECPR.

Barriers to Deceased Donor Procurements: The Saudi Experience.

Barriers to Deceased Donor Procurements: The Saudi Experience.

Education Research: Changes in Medical Students' Knowledge and Attitudes Toward Clinical Death After Teaching the Philosophy of Death

Background and Objectives Varied meanings of death within medicine, bioethics, and society at large often produce disagreement and frustration between physicians and surrogate decision makers. We investigated whether teaching medical students about the philosophical aspects of death would change their attitude toward surrogate decision makers who assert nonstandard views of death. Methods An 80-minute lecture covering philosophical debates surrounding medico-legal standards of death was given to second-year medical students at Oakland University William Beaumont School of Medicine during a neuroscience course. Participants completed a questionnaire containing Likert scale and open-ended questions before and after the intervention assessing their acceptance of, frustration toward, and likelihood of accommodating a request for surrogate decision makers who posited either a whole-brain, high-brain, or circulatory view of death. Change in knowledge was analyzed using the McNemar test, whereas attitudinal scores were compared with paired t tests. Open-ended responses were narratively analyzed to identify themes that elaborate quantitative findings. Results A total of 43 paired responses were analyzed from second-year medical students. Following the intervention, students expressed less frustration ( = −0.64, 95% CI −0.15 to −1.15), greater likelihood of accommodating ventilator removal ( = 0.60, 95% CI 0.41–0.85), and greater acceptance ( = 0.63, 95% CI 0.28–0.91) of surrogates who endorsed a whole-brain view of death. Although students rated the high-brain view as more acceptable after the lecture ( = 0.63, 95% CI 0.28–0.91), they were not more likely to remove a ventilator from a patient who had experienced high-brain death ( = 0.19, 95% CI −0.30 to 0.67). Students were less likely to continue artificial ventilation for a brain-dead patient ( = −0.61, 95% CI −0.91 to −0.30) despite no change in frustration toward the surrogate ( = −0.26, 95% CI 0.20 to −0.70). Discussion Changes in attitudes across the 3 views of death suggest that increased awareness of the philosophical debate facilitates reflection of students' understanding and opinion of death. These findings support implementation of educational interventions to prepare students for future work with surrogate decision makers holding diverse sets of views on death.

Organ donation: psychosocial factors of the decision-making process.

Organ donation has a crucial impact on patient care and survival, of which the worldwide gap between organ demand and supply is currently one of the most challenging issues. Brain-dead patients are the main source of organs that can be donated, but donation requires the consent of family members-a choice that is often complex and stressful and leads to refusal of consent. This mini-review aims to provide an overview of the current knowledge on the impact of certain psychosocial factors on the decision-making process with regard to organ donation by family members. In particular, the influence of several aspects is emphasized, such as sociodemographic factors, knowledge of the organ donation process, religious beliefs, concerns that are related to the choice to donate, and mode of communication. Consistent with this evidence, we emphasize the need to examine these aspects further through interventions and guidelines that improve the organ donation application process and ensure a positive experience for the family that has to make the decision.

Prediction prolonged mechanical ventilation in trauma patients of the intensive care unit according to initial medical factors: a machine learning approach

The goal of this study was to develop a predictive machine learning model to predict the risk of prolonged mechanical ventilation (PMV) in patients admitted to the intensive care unit (ICU), with a focus on laboratory and Arterial Blood Gas (ABG) data. This retrospective cohort study included ICU patients admitted to Rajaei Hospital in Shiraz between 2016 and March 20, 2022. All adult patients requiring mechanical ventilation and seeking ICU admission had their data analyzed. Six models were created in this study using five machine learning models (PMV more than 3, 5, 7, 10, 14, and 23 days). Patients’ demographic characteristics, Apache II, laboratory information, ABG, and comorbidity were predictors. This study used Logistic regression (LR), artificial neural networks (ANN), support vector machines (SVM), random forest (RF), and C.5 decision tree (C.5 DT) to predict PMV. The study enrolled 1138 eligible patients, excluding brain-dead patients and those without mechanical ventilation or a tracheostomy. The model PMV > 14 days showed the best performance (Accuracy: 83.63–98.54). The essential ABG variables in our two optimal models (artificial neural network and decision tree) in the PMV > 14 models include FiO2, paCO2, and paO2. This study provides evidence that machine learning methods outperform traditional methods and offer a perspective for achieving a consensus definition of PMV. It also introduces ABG and laboratory information as the two most important variables for predicting PMV. Therefore, there is significant value in deploying such models in clinical practice and making them accessible to clinicians to support their decision-making.

MP01-17 THALLIUM EXPOSURE TO 3D HUMAN TESTICULAR ORGANOIDS TO STUDY miRNA BIOMARKER EXPRESSION AND DOWNSTREAM mRNA REGULATION

You have accessJournal of UrologyCME1 Apr 2023MP01-17 THALLIUM EXPOSURE TO 3D HUMAN TESTICULAR ORGANOIDS TO STUDY miRNA BIOMARKER EXPRESSION AND DOWNSTREAM mRNA REGULATION Janmejay Hingu, Adam Cohen, Nima Pourhabibi Zarandi, Anthony Atala, and Hooman Sadri-Ardekani Janmejay HinguJanmejay Hingu More articles by this author , Adam CohenAdam Cohen More articles by this author , Nima Pourhabibi ZarandiNima Pourhabibi Zarandi More articles by this author , Anthony AtalaAnthony Atala More articles by this author , and Hooman Sadri-ArdekaniHooman Sadri-Ardekani More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003212.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Previous studies have demonstrated that heavy metal exposure can negatively impact male infertility and testicular carcinogenesis due to increased oxidative stress. This can lead to molecular dysfunction, part of which is mediated by small non-coding RNA known as miRNA, which may serve as potential biomarkers of disease. We present a miRNA analysis following thallium exposure to three-dimensional human testicular organoids (HTOs). METHODS: 3D HTOs were created from 2D testicular cell cultures derived from three brain-dead adult patients. HTOs were exposed to either thallium or ultrapure water. The miRNA analysis was performed using the Nanostring nCounter Human v3b miRNA panel, representing 827 unique miRNA probes. Nanostring nSolver 4.0 was used to execute target normalization with the geometric mean of the top 100 miRNAs detected, followed by background subtraction of 57 counts, which was the average of exogenous negative controls in the panel plus two standard deviations. All miRNAs with average counts <5 within a sample group were excluded to ensure robust expression. Qiagen Ingenuity Pathway Analysis (IPA) miRNA target filter was used to select for experimentally observed mRNAs associated with reproductive pathology and testis cells. RESULTS: 9 miRNAs were uniquely expressed within the thallium HTOs compared to 3 in the control. Seven of the 107 miRNAs expressed in both were significantly differentially expressed (miR-574-3p, miR-374a-5p, miR-423-5p, miR-106a-5p+miR-17-5p, miR-29b-3p, and miR-26b-5p were upregulated; miR-145-5p was downregulated). However, none survived the application of the false discovery rate. IPA miRNA target filter showed that these miRNAs regulated 161 mRNAs, including BCL2, MYC, CDKN1A, CCNA2, CCND1, and E2F1. CONCLUSIONS: Certain miRNAs have previously been linked to male infertility (miR-145-5p, miR-574-3p, miR-26b-5p), asthenozoospermia (miR-423-5p), and testicular diffuse large B-cell lymphoma (miR-17-5p). Previous studies have also demonstrated that oxidative stress from thallium-containing compounds can induce apoptosis by affecting Bcl-2 (BCL2) expression and activate nucleolar stress by altering c-Myc (MYC) and p21 (CDKN1A) expression. Thallium has also been shown to modify cell cycle progression through cyclin A (CCNA2), cyclin D1 (CCND1), and E2F-1 (E2F1). Although only 4 of these miRNAs have been implicated in male infertility and testicular cancer, further studies may elucidate other miRNAs and their downstream regulation of mRNA. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e9 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Janmejay Hingu More articles by this author Adam Cohen More articles by this author Nima Pourhabibi Zarandi More articles by this author Anthony Atala More articles by this author Hooman Sadri-Ardekani More articles by this author Expand All Advertisement PDF downloadLoading ...

Qualitative Evaluation of Intracranial Pressure Slopes in Patients Undergoing Brain Death Protocol

Due to the importance of not mistaking when determining the brain death (BD) diagnostic, reliable confirmatory exams should be performed to enhance its security. This study aims to evaluate the intracranial pressure (ICP) pulse morphology behavior in brain-dead patients through a noninvasive monitoring system. A pilot case-control study was conducted in adults that met the BD national protocol criteria. Quantitative parameters from the ICP waveforms, such as the P2/P1 ratio, time-to-peak (TTP) and pulse amplitude (AMP) were extracted and analyzed comparing BD patients and health subjects. Fifteen patients were included, and 6172 waveforms were analyzed. ICP waveforms presented substantial differences amidst BD patients when compared to the control group, especially AMP, which had lower values in patients diagnosed with BD (p < 0.0001) and the TTP median (p < 0.00001), but no significance was found for the P2/P1 ratio (p = 0.8). The area under curve for combination of parameters on the BD prediction was 0.77. In this exploratory study, noninvasive ICP waveforms have shown potential as a screening method in patients with suspected brain death. Future studies should be carried out in a larger population.

A Critical Ethnographic Study of Families of Brain-Dead Patients: Their Experiences and Attitudes to Organ Donation.

Despite the difficulty of making decisions providing facilitating mediators and removing barriers to making decisions about choosing the right path to donate the organs of brain-dead patients by families can assist in improving the services and help the lives of fellow human beings. This study aimed to explain the decision-making mediator for organ donation in families with brain-dead patients in a cultural context. This qualitative study with a critical ethnographic approach was conducted based on Carspecken's stages from August 2021 to March 2022. In this regard, 22 participants were selected through the purposive sampling method and considering the inclusion and exclusion criteria. Sampling was continued until data saturation. After obtaining the required ethical approval, data collection was performed through observation, semi-structured interviews, and document review. All data were recorded and managed using MAXQDA 18 software. Based on the results, the main themes and subthemes of this study included "inefficient decision-making mediator" (the shadow of the socioeconomic situation on the medical status of organ recipients, as well as pessimistic influential individuals, social accountability, dialect difference, and ethnic beliefs) and "efficient decision-making mediator" (social learning, material, and spiritual motivation, mother role, and divine reward). The results of this study, derived from a cultural context, can be applied to carrying out future applied and empirical research. Moreover, they can be used in the field of various nursing roles, especially management, care, and education.

Islamic Perspective on Organ Donation and Brain Death

Worldwide and in the countries, Islamic scholars do not have a consensus on the criteria and definition of brain death. This lack of consensus on the definition of brain death and its legal status has resulted in delays in withdrawal of care and futile care to the brain-dead patient population that negatively strains the limited resources for human organs in the Islamic community. Also, Islamic countries with organ transplantation resources lack legislation on endorsing brain death and its legal status as death which creates delays in harvesting viable organs from eligible donors. These delays can negatively impact the life quality of patients with end-organ failure waiting for an organ and make organs non-viable for transplantation, adding to the already existing shortages in Islamic countries. This brief review aims to clarify some of the barriers in the determination of brain death and organ donation in Islamic countries and address religious and ethical issues that exist that affect issues of access.

Care of the brain dead organ donor

Organ donation is becoming more common but there is still a large gap between the number of people requiring transplants and the organs donated. There are set criteria for organ donation. When organ donation is considered after brain death, the physician must ensure that the prerequisites for testing are met and proceed to establish brain death using standard guidelines. The pathophysiological changes that occur after brain death must be borne in mind and utmost care should be given to counter those changes that would result in dysfunction of the donated organs. The brain dead patient must be maintained as stable as possible in the ICU. General nursing and medical care must continue. Core temperature must be maintained and infections must be treated. Blood pressure is best maintained with fluids and minimal vasopressors. Low tidal volume ventilation, optimal levels of positive end-expiratory pressures to maintain minimal FIO2, will maintain airways open and reduce extravascular lung water. Maintain euvolaemia. Maintain urine output at 0.5–3 ml/kg/h. Electrolyte abnormalities must be corrected. Maintain blood glucose concentrations between 120-180 mg %. Triple hormonal therapy improves organ function. Organ retrieval is performed in an operation theatre and a well conducted anaesthetic care is essential for the viability of these organs. One brain-dead organ donor can potentially donate ‘lives’ to eight individuals. To enhance or preserve the maximum potential of the donated organs, the anaesthesiologist and intensivist play a vital role in preserving the organs as best as possible.

Intensive care nurses' experiences with brain-dead patients - a phenomenological qualitative study

Aim: This study explores nurses&#8217; experiences of caring for (potentially) brain-dead patients. Design: A qualitative interpretative phenomenological design was chosen to describe the phenomenon in all its complexity and dimensions. Methods: In 2016, twelve episodic interviews were conducted with intensive care nurses from six wards. The interviews related to their experiences of caring for (potentially) brain-dead patients and were analyzed according to Benner&#8217;s Interpretative Phenomenology. Results: Three key phenomena were generated: 1) The brain is dead; the body is alive; 2) Coping within high performance medicine and 3) Power(-lessness). The participants&#8217; experience was that caring for a (potentially) brain-dead patient and explaining brain death to the patient&#8217;s relatives is very demanding. In the intensive care unit, nurses are required to diligently provide exemplary methodical and routine care, most of the time without an outlet to relieve their own work-related burdens. In some situations, the interviewees felt powerless. Conclusion: The data collected have provided a deeper insight into the situation intensive care nurses face when caring for (potentially) brain-dead patients. Nevertheless, the authors recommend further research on all phenomena, and also the design of appropriate training and support for nurses.

Relationships Between Resting Energy Expenditure and Transcranial Doppler Measurements in Patients With and Without Brain Death.

Introduction Brain metabolism deteriorates during brain death, suggesting that cerebral metabolic measurements could serve as a prognostic factor. The application of transcranial Doppler can be useful in evaluating patients evolving to brain death. Resting energy expenditure is lower than expected in patients with brain death, and this is caused by the decrease in cerebral blood flow and consequently lower oxygen supply. The primary aim of this retrospective study is to investigate the early metabolic changes in patients with clinical criteria of brain death and examine if these changes are related to a gradual decrease in blood flow velocities in the middle cerebral artery. Methods All consecutive patients from 1st June 2018 to 30th April 2022, admitted to the ICU with brain injury and a GCS ≤8, were included retrospectively in the study. Patients were allocated into two groups: Group A, patients without clinical signs of brain death (n = 32), and Group B, patients with brain death (n = 34). In each group, three sets of metabolic measurements were performed concomitantly with cerebral blood flow velocities using transcranial Doppler (a) upon admission to the ICU, (b) once hemodynamic stabilization was obtained, and (c) 48 hours after their hemodynamic stabilization or when brain death was confirmed by clinical criteria. Resting energy expenditure (REE) measurements were performed using a metabolic computer. Cerebral blood flow velocities were measured after a period of 30 min using a 2-MHZ 2D ultrasound probe. Results Brain-dead patients had a significant decrease in their metabolic parameters as the cerebral blood flow velocities recorded with the transcranial Doppler deteriorated, (REE Group A = 1667.65 ± 597 vs Group B = 1376.12 ± 615, p = 0.05 and REE predictedGroup A = 113.19 ± 44.9 vs Group B = 93.29 ± 41.5, p = 0.066 for measurement 1;REE Group A = 1844 ± 530.9 vs Group B = 1219.97 ± 489, p < 0.001 and REE predictedGroup A = 124.38 ± 39 vs Group B = 81.35 ± 30.4, p < 0.001 for measurement 2; REE Group A = 1750.97 ± 414, p < 0.001 and REE predicted Group A = 116.38 ± 19.2 vs Group B = 56.09 ± 19.6, p < 0.001 for measurement 3).Multiple stepwise regression analysis revealed a strong relationship between age, the worsening of the blood flow velocities pattern, and the decrease in REE (multiple R = 0.264, F = 5.55, p = 0.009).Furthermore, a statistically significant correlation was found between temperature and REE (correlation coefficient = 0.500, 0.674, 0.784 for measurements 1, 2, and 3, respectively, and p < 0.001 for all measures). Conclusions In brain-dead patients, the gradual decrease in cerebral blood flow leads to a decrease in REE as well as thermogenetic control. These changes can be detected early after the patient's admission to the ICU.

Liver Transplantation Using Allografts With Recent Liver Blunt Trauma: A Nationwide Audit From the French CRISTAL Biomedicine Agency Registry.

In the current setting of organ shortage, brain-dead liver donors with recent liver trauma (RLT) represent a potential pool of donors. Yet, data on feasibility and safety of liver transplantation (LT) using grafts with RLT are lacking. All liver grafts from brain-dead donors with RLT proposed for LT between 2010 and 2018 were identified from the nationwide CRISTAL registry of the Biomedicine Agency. The current study aimed at evaluating 1-y survival as the primary endpoint. Among 11 073 LTs, 142 LTs (1.3%) using grafts with RLT were performed. These 142 LTs, including 23 split LTs, were performed from 131 donors (46.1%) of 284 donors with RLT proposed for LT. Transplanted grafts were procured from donors with lower liver enzymes levels ( P < 0.001) and less advanced liver trauma according to the American Association for the Surgery of Trauma liver grading system ( P < 0.001) compared with not transplanted grafts. Before allocation procedures, 20 (7%) of 284 donors underwent damage control intervention. During transplantation, specific liver trauma management was needed in 19 patients (13%), consisting of local hemostatic control (n = 15), partial hepatic resection on back-table (n = 3), or perihepatic packing (n = 1). Ninety-day mortality and severe morbidity rates were 8.5% (n = 12) and 29.5% (n = 42), respectively. One-year overall and graft survival rates were 85% and 81%, and corresponding 5-y rates were 77% and 72%, respectively. Using liver grafts from donors with RLT seems safe with acceptable long-term outcomes. All brain-dead patients with multiorgan trauma, including liver injury, should be considered for organ allocation.

The Significance of the Nucleic Acid Test (NAT) to Prevent Viral Contamination in Musculoskeletal Tissue Transplantation.

Objective The present study aims to highlight the significance of the nucleic acid test (NAT) for musculoskeletal tissue donation and to compare the sensitivity of this test on the different available platforms. Method The present study is a retrospective survey in a human tissue bank database and an integrative literature review encompassing the last 10 years. The PubMed portal and the SCOPUS, CINAHL, and Web of Science databases were queried for articles. Results We found no specific studies on the use and sensitivity of NAT in braindead tissue donors. The information presented in the present study consists of specific contents intended for the Brazilian Blood Transfusion Network (Hemorrede Transfusional Nacional, in Portuguese) and internal retrospective data from a tissue bank located at a city in the state of São Paulo, Brazil. Conclusions The NAT is effective in blood samples from living patients. However, since biochemical reactions in braindead patients can be different, specific research, platforms, or both are crucial to tissue banks.

Reasoning about Death in Biomedical Decision-Making.

Depending on our mode of reasoning-moral, prudential, instrumental, empirical, dialectical, and so on-we may come to vastly different conclusions on the nature of death and the appropriate orientation toward matters such as euthanasia or procuring organs from brain-dead patients. These differing orientations have resulted in some of the most enduring conflicts in biomedical decision-making with roots in the earliest strands of philosophical discourse. Through continually grappling with questions over matters of death, we continually step closer to clarity, even if certainty on these matters remains necessarily as elusive as death itself.

Bile Collected From the Normal Gallbladder of Patients During Surgery Has Simple Bacterial Flora.

BackgroundBile inhibits bacterial growth because it is rich in bacteriostatic compounds such as bile acids. Analytical techniques using a high-intensity sequencer recently revealed bacterial flora in the bile of normal gallbladders in brain-dead patients. Therefore, we performed a microbial flora analysis of bile collected from pathologically normal gallbladders surgically removed from patients with hepatobiliary pancreatic diseases and normal liver function.MethodsBacterial DNA was extracted from bile samples and analyzed using 16S rRNA sequencing.ResultsThe culture results of all 12 bile samples were negative. However, the results of the 16S ribosome gene analysis suggested the presence of bacterial flora in all samples. The phyla Firmicutes, Proteobacteria, Actinobacteria, and, more specifically, the genera Anaerobacillus, Delftia, Bacillus, Ralstonia, Ochrobactrum, Acidovorax, and Curvibacter were detected in all 12 samples. The results of the 16S rRNA gene profile analysis revealed that Anaerobacillus and Delftia accounted for 58.62%-87.63% of the bacteria identified in each sample.ConclusionIn a bacterial flora analysis targeting the 16S ribosomal gene, a specific bacterial flora was detected in bile collected from the pathologically normal gallbladders of patients with hepatobiliary pancreatic diseases. Although a diverse bacterial flora was previously reported in the bile of brain-dead patients, the present results revealed a simple bacterial flora with no diversity in the bile samples.

How many ways can you die? Multiple biological deaths as a consequence of the multiple concepts of an organism

According to the mainstream position in the bioethical definition of death debate, death is to be equated with the cessation of an organism. Given such a perspective, some bioethicists uphold the position that brain-dead patients are dead, while others claim that they are alive. Regardless of the specific opinion on the status of brain-dead patients, the mere bioethical concept of death, according to many bioethicists, has the merit of being unanimous and univocal, as well as grounded in biology. In the present article, we challenge such a thesis. We provide evidence that theoretical biology operates with a plurality of equally valid organismic concepts, which imply different conclusions regarding the organismal status of a brain-dead patient. Moreover, the theoretical biology concepts of an organism are very distant from the view on an organism that appears by way of bioethicists theorizing on death. We conclude that if death is to be understood as the cessation of an organism, there is no single correct answer to the question of whether a brain-dead patient is alive or dead.