Concept Of Brain Death Research Articles

Brain Death Between Jurisprudence and Medical Innovation

This study aims to explore the multiple concepts of brain death through jurisprudence and medical innovation. The study focuses on understanding the interaction between these concepts and analyzing the challenges and problems they face. To analyze the multiple concepts of brain death and provide a comprehensive and balanced understanding of this issue from different perspectives. And also to know the ethical and legal challenges associated with determining brain death. The study included the jurisprudential, medical, ethical and legal community interested in the topic of brain death. The study followed a multidimensional approach and is guided by the methodology of literature review, comparative analysis, and applied analysis of medical trials. Previous studies and research were reviewed, including jurisprudential, medical, ethical and legal studies. The results showed a significant discrepancy in understanding and application between the jurisprudential concept of death and recent medical developments to address the ethical and legal challenges associated with determining brain death. The recommendations and directions for health and legal policies were to achieve harmony between the jurisprudential, medical and ethical dimensions of the issue of brain death. The research indicates the need for further research and analysis to better understand the interaction between the multiple concepts of brain death and to apply comprehensive and balanced solutions.

A 25-year scoping review of the organ donation system in Malaysia: past, present, and future.

Organ donation and transplantation are integral components of modern medicine. This scoping review thoroughly explores the historical evolution, current status, and future prospects of organ donation and transplantation in Malaysia. Historically, Malaysia faced significant challenges in establishing a robust organ transplantation system, with various factors hindering organ donation efforts. Currently, Malaysia continues to struggle with stagnant donation rates despite collaborative efforts from various sectors. There is an urgent need to amend the 50-year-old Human Tissue Act to strengthen the legal framework for organ donation and address ethical concerns. Looking to the future, Malaysia could adopt a soft opt-out system and prioritize advancements in organ preservation techniques by exploring new sources of organs through the donation after circulatory death program. Continued efforts are necessary to enhance education programs for professionals and the public, dispelling myths about organ donation and effectively educating on the concepts of brain death. Malaysia strives to create a more accessible future for organ transplantation, aligning with the Sustainable Development Goals to reduce the burden of organ failure and improve the population's health and well-being.

Cadaveric organ donation: Indian perspective

Cadaveric organ donation in India, although started long back; its present status is not favourable. The percentage gain is very slow in comparison to most of the country even after having proper legislation. There are many reasons for this, lack of awareness being the most common. Most of the people does not know the concept of brain death. Although government and many NGOs are attached with it and are trying their level best to communicate with people for this noble cause, they have not yet reached the expected goal.To boost up the process of cadaveric organ donation, the hospitals and their staff including doctors must play a vital role. Hence, knowledge and orientation of such potential group is important for further processing because in most of the hospitals even doctors are not well-informed about the legal and ethical aspects of organ donation. If all the weak locus are addressed properly, we can definitely achieve the goals within a short span of time.

Conhecimento ético e deontológico dos estudantes de medicina sobre a doação de órgãos e tecidos no Brasil

Organ donation and transplantation have been taking place in Brazil for decades, acting as an effective alternative for individuals who do not benefit from conventional treatments. This requires a regulatory framework that allows for organ removal while respecting bioethical and legal standards. This study aims to assess the knowledge of future health professionals regarding the ethical and deontological issues involved in organ and tissue donation. This descriptive and qualitative study was carried out with medical students from the first to the fifth year at a university in the west of the state of Paraná, Brazil, with a sample of 131 participants. The results showed 84.7% of students had never attended classes on the subject during their undergraduate years. Despite this lack of formal education, 53.4% correctly identified the concept of brain death. Additionally, 94.7% expressed willingness to donate their organs and 31% believed certain groups should be excluded from the transplant list. The findings suggest a gap in university curricula regarding the subject, yet students are actively seeking alternative ways to gain knowledge. Moreover, there was a high acceptance rate among students for post-mortem organ donation. Opinions diverged significantly on ethical and individual issues such as the exclusion of people from the transplant list.

Perceptions of intensive care nurses on the concepts of brain death and coma: a metaphor analysis

Aims: Intensive care nurses take active roles in the treatment and care practices of patients who are in critical condition and who develop neurological problems such as coma and brain death. Nurses need to have knowledge about the subject and take precautions against ethical problems. This study aimed to determine the perceptions of intensive care nurses about the concepts of brain death and coma through metaphors. Metaphor analysis was used as a qualitative research method. Methods: Using content analysis, 20 intensive care nurses produced 20 different metaphors for the question, “Coma is similar to ..., because ...”. Nurses mostly likened the concept of a “coma” to a “plant”, “stay together”, and “deep sleep”. They also produced 20 different metaphors for the question, “Brain death is similar to ..., because…”. Results: Nurses mostly likened the concept of brain death to a “plant”, “absolute death”, and a “coma”. Brain death and a coma were common to three of the metaphors produced by nurses (“uncertainty/unresponsiveness”, “death/eternity”, and “permanent breakdown” metaphors). The answers given to the questions about the concepts of brain death and a coma were “uncertainty/unresponsiveness”, “death/eternity”, and “permanent breakdown” metaphors. The nurses confused the concepts of a coma and brain death with each other and had similar perceptions of the two concepts. Conclusion: Three of the metaphors produced by nurses were common “uncertainty/unresponsiveness”, “death/eternity”, and “permanent breakdown”. Metaphors produced by the nurses regarding the concept of brain death were categorized as disaster and support.

The conceptual injustice of the brain death standard.

Family disputes over the diagnosis of brain death have caused much controversy in the bioethics literature over the conceptual validity of the brain death standard. Given the tenuous status of brain death as death, it is pragmatically fruitful to reframe intractable debates about the metaphysical nature of brain death as metalinguistic disputes about its conceptual deployment. This new framework leaves the metaphysical debate open and brings into focus the social functions that are served by deploying the concept of brain death. In doing so, it highlights the epistemic injustice of medicolegal authorities that force people to uniformly accept brain death as a diagnosis of death based on normative considerations of institutional interests, such as saving hospital resources and organ supplies, rather than empirical evidence of brain death as death, which is insufficient at best and nonexistent at worst. In light of this injustice, I propose the rejection of the uniform standard of brain death in favor of a choice-based system that respects families' individualized views of death.

Brain death: from the transformation of medical concept to the change of medical practice

The implementation of death determination by clinicians usually involves three steps: learning the concept of death, mastering the skills of death determination, and recording the results of death determination. Each process needs to be changed with the progress of medical science. The transformation of brain death concept is the establishment and formation of the latest cognition of "irreversible brain function", which needs to be completed based on the theoretical learning of recognized standards. The transformation of brain death determination is the learning and mastering of the latest skills of brain death determination, which requires relearning and retraining based on special technologies. The transformation of brain death determination is the habit formation of standardized records of brain death judgement results, which needs to be completed based on the continuous improvement of case quality control. The gradual advancement of the three steps will accelerate the process of determining brain death in China.

Legal thanatology and the right to death: problems and prospects for studying somatic human rights

The article examines the somatic rights of a person through the prism of «discourse of death». Emphasis is placed on the problems of legal thanatology as a science about death. Philosophical, religious and cultural differences in concepts and definition of human death. It is noted that an important component of medical thanatology is the concept of thanatogenesis – the causes and mechanisms of the onset of death, a set of interdependent pathological processes that lead to the onset of clinical or biological death. Knowledge of the basic patterns of thanatogenesis and detection of changes that trigger the process of thanatogenesis are necessary for timely and adequate correction of critical conditions that occur in patients. The time of death of a person is the moment of his brain death or his biological death (irreversible death of a person). Brain death can occur with complete and irreversible cessation of all its functions, which is registered with a working heart and artificial ventilation of the lungs. The methodology for diagnosing death is not related to the concept that there are different types of death. Loss of cardiovascular and respiratory function can lead to death only when ischemia and anoxia are prolonged enough to cause irreversible brain damage. Legal thanatology should be considered as an independent direction in modern jurisprudence within the framework of general theoretical jurisprudence. It is related to medical bioethics, medical law, and, from this point of view, it identifies the gaps that exist in jurisprudence and medicine and, if possible, eliminates them. Legal thanatology is a kind of «bridge» and «filter» of achievements in the field of medicine and legal science, which further helps law to «go hand in hand» with medicine. It was concluded that in the conditions of an increase in the number of donor centers, the extreme ethical importance of diagnosing brain death determines the need for high accuracy, speed and safety of its establishment. The above data show that the problem of brain death, as before, remains an open scientific problem. The concept of brain death continues to develop, refine, and improve. Any new circumstances (clinical observations, scientific facts) have to be tested again and again as arguments in defense of life or in defense of death. Key words: human rights, right to death, somatic rights, legal thanatology, death, human body, time of death, brain death.

Attitudes of healthcare professionals working in different fields towards organ transplantation in the hospital sample and the factors affecting these attitudes.

Aim: Turkish society has profound distrust and hesitation against the concept of brain death and related cadaveric organ donation. In this study, the attitudes of health workers about organ transplantation from cadavers were investigated. The effects of race, religiosity and political conservatism parameters on the attitudes of the research group were also explored. Methods: A total of 491 participants between the ages of 18-70 who are hospital employees in different fields were included in this study. An Organ Donation Attitude Scale (ODAS) was applied to the participants, which evaluates organ donation from cadavers explicitly, and the relationships between the emerging trend and the demographic characteristics of the participants, their education, the task they are responsible in the hospital, ethnicity and sectarian origins, religiosity and political conservatism characteristics were evaluated. Results: ODAS scores of our sample group did not show a significant relationship in age, gender, ethnic origin and sect. There was a negative relationship between cadaveric organ transplantation and religiousness and a positive relationship with liberal political views. On the other hand, there was a significant difference in the attitude toward organ transplantation regarding education levels, position in the hospital, and the geographical region where the person came from. Conclusion: Our country's attitude towards organ transplantation from cadavers is complex in a way that cannot be explained only by education. A conceptual study of cultural, religious and other social aspects is necessary to explain the perspective towards organ transplantation in Turkey.

Barriers to Deceased Donor Procurements: The Saudi Experience.

Barriers to Deceased Donor Procurements: The Saudi Experience.

Forced Organ Harvesting

Forced Organ Harvesting

Overcoming Challenges of Deceased Organ Donation in Indian Private Hospitals.

Overcoming Challenges of Deceased Organ Donation in Indian Private Hospitals.

Medical Students Perception about the Donation and Transplantation of Organs and Tissues

Objective: To evaluate medical students’ perception about organ and tissue donation and transplantation. Methods: This is a cross-sectional study, with quantitative analysis, which evaluated students from the 1st to the 12th semester of the Bahia Medical School of the Bahia Federal University (FMB/UFBA), grouped by year of graduation (1st to 6th year), through a questionnaire. Data were statistically analyzed using R for Windows, considering significant values of p ≤ 0.05. Results: Of the 393 participants, 207 (52.7%) were female, 250 (63.3%) were between 21 to 25 years old, 144 (36.6%) had no religion, and 80 (20.3%) were boarding students. Of all the interviewees, 159 (40.5%) self-assessed their knowledge as regular and 153 (38.8%) as bad and terrible. About the exposure to the subject, 222 (56.6%) had never attended a class and, among those who had, 187 (60.1%) evaluated the information as insufficient. A total of 324 students (82.4%) would have the intention of being a post-mortem donor and 42 (61.6%) would accept to participate in a living donor transplantation, although 245 (62.3%) said they did not know the risks. Among the students, 327 (83.2%) said they knew the concept of brain death, 119 (30.3%) the legal terms of donation, and 105 (26.7%) the donor maintenance measures. However, 72 (18.3%) said they had a good knowledge of how to diagnose brain death. A total of 275 (70%) got right what is needed to declare a donor. There were 359 answers that would exclude alcoholics, smokers and users of illicit drugs from the transplant list, and 363 (92.7%) considered that the severity of the problem is the most appropriate criterion for priority on the waiting list. Conclusion: Students perceive their level of knowledge as unsatisfactory and understanding about specific issues is still low. No significant influence of sociodemographic aspects was observed regarding the desire to be a donor.

The role of neuroimaging in the determination of brain death.

Brain death is the irreversible cessation of all brain function. Although protocols for its determination vary among countries, the concept of brain death is widely accepted, despite ethical and religious issues. The pathophysiology of brain death is related to hypoxia and ischemia in the setting of extensive brain injury. It is also related to the effects of brain edema, which increases intracranial pressure, leading to cerebral circulatory arrest. Although the diagnosis of brain death is based on clinical parameters, the use of neuroimaging to demonstrate diffuse brain injury as the cause of coma prior to definitive clinical examination is a prerequisite. Brain computed tomography (CT) and magnetic resonance imaging (MRI) demonstrate diffuse edema, as well as ventricular and sulcal effacement, together with brain herniation. Angiography (by CT or MRI) demonstrates the absence of intracranial arterial and venous flow. In some countries, electroencephalography, cerebral digital subtraction angiography, transcranial Doppler ultrasound, or scintigraphy/single-photon emission CT are currently used for the definitive diagnosis of brain death. Although the definition of brain death relies on clinical features, radiologists could play an important role in the early recognition of global hypoxic-ischemic injury and the absence of cerebral vascular perfusion.

Eugène Bouchut's (1818-1891) Early Anticipation of the Concept of Brain Death.

The conventional historical account of the concept of brain death credits developments and discoveries of the twentieth century with its inception, emphasizing the role of technological developments and professional conferences, notably the 1968 Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death. This essay argues that the French physician Eugène Bouchut anticipated the concept of brain death as early as 1846. Correspondence with Bouchut's understanding of brain death and one important contemporary concept of brain death is established then contrasted with current trends of defining death as the death of the brain. The philosophical factors that influenced Bouchut and the later developments of concepts of brain death are considered, with special reference to mechanistic philosophy and vitalism.

Knowledge, attitudes and willingness to organ donation among the general public: a cross-sectional survey in China

BackgroundThe purpose of this study is to assess the level of knowledge, attitudes, and willingness to organ donation among the general public in China.MethodsThe study population consisted of 4274 participants from Eastern, Central and Western China. The participants’ knowledge, attitudes and willingness to organ donation were collected by a self-designed questionnaire consisting of 30 items. Knowledge is measured by 10 items and presented as a 10 point score, attitudes is measured by 20 items using a 5-step Likert scale and total score ranged between 0 and 80; while the willingness to donate is assessed as binary variable (0 = No; 1 = Yes). A logistic regression model was used to assess the association of knowledge and attitudes with willingness to organ donation, controlling for demographic and socioeconomic confounders.ResultsThe questionnaire response rate was 94.98%. The mean score (± SD) of the general public’s knowledge to organ donation was 6.84 ± 1.76, and the mean score (± SD) of attitudes to organ donation was 47.01 ± 9.07. The general public’s knowledge and attitudes were the highest in Eastern China, followed by West and Central China. The logistic regression model indicated a positive association between knowledge and the willingness to organ donation (OR = 1.12, 95%CI: 1.08, 1.17; P < 0.001); attitudes were also positively potential determinant of more willingness to organ donation (OR = 1.08, 95%CI: 1.07, 1.09; P < 0.001).ConclusionsKnowledge and attitudes were found to be positively associated with the Chinese general public’s willingness to organ donation. Knowledge about the concept of brain death and the transplant procedure may help raise the rate of willingness to organ donation.

The influence of socioeconomic factors on deceased organ donation in Iran.

BackgroundThere is a large gap between the number of patients on organ waiting lists and the number of available organs for donation. This study investigated the socioeconomic factors in Iran that influenced decisions for organ donation among the families of brain-dead donors.MethodsThis retrospective cross-sectional study was performed among the families of 333 organ donors in Iran. Two trained researchers interviewed family members about the donor’s age, sex, cause of brain death, education level, marital status, number of children, history of addiction, the financial status of the donor’s family, and reasons for which they considered refusing organ donation.ResultsThe mean age of the donors was 37.23±16.59 years. During 2017–2019, significant differences were found according to income (P<0.001), marital status (P<0.001), sex (P=0.04), and occupation (P=0.04). More than half of the organ donors were of low socioeconomic status, and nearly half were the sole income earners of large families. Trauma was the most common cause of death (44.6%). The most common reasons for which the families considered refusing organ donation were unfamiliarity with the concept of brain death, denial, and the expectation of a miracle.ConclusionsThe donor’s socioeconomic status and availability of social services, such as insurance coverage, psychological services, and mourning therapy courses, play an important role in organ donation. Adequate support for the deceased’s family after organ donation is imperative.

Brain death and the internet: evaluating the readability and quality of online health information.

Brain death has been accepted medically and legally as biological death. Nevertheless, it is a difficult concept for the public to understand, resulting in a reliance on online resources for clarity. When the information is inaccurate, misleading, or elusive, the internet could have adverse effects on the public's decision-making. Here we aimed to assess the quality and readability of information regarding brain death on the internet. The five most popular search engines were queried using the keyword 'brain death' and the top 30 websites of each search engine were evaluated. Authorship was classified as medical or public. Gunning Fog Index (GFI) and Flesch Reading Ease Score (FRES) were calculated to analyze readability. The LIDA was used to assess quality. The overall LIDA score was 60,3%, with a mean score of 60.8%, 60.7%, and 59.3% for accessibility, usability, and reliability, respectively, indicating a moderate level. The accessibility of medical websites (P=0.037) and the reliability of public websites (P=0.031) were found to be significantly weaker. The average FRES was 41.6±14.6 rated as difficult, and the mean GFI was 15.7±3.4, indicating mean readability at "difficult, grade >10". Online health information on brain death exceeds the National Institutes of Health recommended reading levels. Our results emphasize the need to establish quality guidelines to improve the comprehensiveness of health website content. Brain death is still a contentious topic; therefore, reliable, and easy-to-read online educational materials can help public understand the concept of brain death and potentially improve the transplant rate.

THE HUMAN RIGHT TO TRANSPLANTATION OF ORGANS AND TISSUES: MEDICINE, ETHICS AND LAW.

The aim: To study the combination of medical, legal, ethical principles and regulations in the field of transplantology, as one of the key problems of bioethics. Materials and methods: Formal-logical methods of analysis and synthesis allowed to reveal the content of the concepts that make up the subject of research, to classify them, as well as to formulate intermediate and general conclusions. The systematic method allowed to study the role and significance of human right to transplantation among other somatic human and civil rights and freedoms. Using the historical method, the doctrinal basis of the study was analyzed, and the main stages of the formation of human right to transplantation were identified. Conclusions: The level of modern development of the Institute of Transplantology depends primarily on the tolerance of the society itself regarding the concept of brain death. The actual normalization of the concept of death in one or another state determines the level of realization of the human right to organ and tissue transplantation. Regarding the reform of the current legislation in the field of transplantology, as one of the key problems of bioethics, first of all, moral principles should be taken into account (at the same time, today morality in its development is even slightly ahead of the development of international law, although progressive principles of legal regulation of transplantation processes have been distinguished at the international level ). Therefore, during the development of norms of both international and national law regarding transplantology, existing moral principles should be taken as a basis. At the same time, one should not forget that a necessary factor is the presentation of a number of issues for public discussion, as well as their discussion at scientific and practical conferences not only of doctors and lawyers, but also of theologians and philosophers.

International Population Study in Spain, Cuba, and the United States of Attitudes Toward Organ Donation Among the Cuban Population.

Cuban immigrants constitute an important group in both the United States and Spain, with different behaviors toward organ donation having been described among the different Latin American nationalities. We analyzed the attitude toward organ donation among the Cuban populations in Cuba, Spain, and Florida. The study population was Cuban immigrants over 15years of age residing in Cuba, Spain, and Florida, with samples randomly stratified by age and sex. A validated questionnaire on psychosocial aspects of organ donation (PCID-DTO Rios) was used. Census was used as the sampling base in all 3 countries; however, additionally, in Spain and the United States (Florida), we sought the support of immigration support associations to determine the Cuban population without legal documentation. The questionnaire was completed anonymously and self-administered. The completion rate of the study was 74% (4123/5574) among 424 surveyed in Spain, 1224 in Florida, and 2475 in Cuba. The attitude in favor of donating their own organs upon death was 60.6% of those surveyed in Spain, 37.6% in Florida, and 68.9% in Cuba, or 58% of the global sample. Multivariate analysis showed that country of residence was an independent factor associated with attitude toward organ donation (odds ratio,1.929). Other factors associated with attitude were sex, educational level, performance of prosocial activities, knowledge of the brain death concept, religion, the couple's opinion toward donation, fear of mutilation after donation, and attitude toward manipulation of the body after death. The attitude toward organ donation among Cubans in their country of origin and immigrants in Spain was similar, being significantly different from those who emigrate to Florida, where the attitude is much less favorable.