Criteria For Death Research Articles

"The Brain as a Whole" Concept: Facilitating Approaches to Brain Death Understanding (Short Communication)

James Bernat claimed that "the formulation of whole-brain death provides the most congruent map for our correct understanding of death". However, the author has recently proposed the categorization of another phrase: "brain as a whole (BAAW)". This is because patients with primary brainstem lesions who otherwise meet the clinical criteria for BD may still have EEG, CBF, evoked potentials, and hypothalamic-pituitary neurosecretion.Bernat and colleagues suggested "tightening the clinical tests for brain death or loosening the whole-brain criterion of death". They emphasize that the BAAW criterion is an intermediate standard between the whole-brain and brainstem views, tolerating the irreversible cessation of critical brain functions, whereas the BD/DNC determination does not require the cessation of all brain functions or the death of every neuron.In this paper, we have revised the concept of BAAW, which is intuitive and facilitates a conceptual and practical approach, but requires further refinement to specify precisely which brain functions must cease at brain death and which may continue.

Philosophical and Moral Issues of Organ Transplantation at the Close of the Twentieth Century.

Editor's note: Organ transplantation and the associated ethical topics such as the criteria for brain death continue to be of critical interest to Catholics, both physician and lay. Thirty years ago, Fr. Joseph Howard took a look at the philosophical and moral aspects of organ transplantation, and his words are still relevant today. New, recent insights into the residual functioning of the brain in the face of extensive injuries pose an additional question for Catholic physicians: to what extent do we owe a duty to our patients to explain to them the nature of the uncertainties and debates surrounding both donation and transplantation, in order for them to make an informed decision for themselves or their loved ones? Linacre Quarterly. 1994 Nov;61(4):57-64.

Beyond the Harvard Definition: A Critique of Josef Seifert’s Realistic Phenomenological Approach to Brain Death

This article explores the significance of context in defining death, particularly through the lens of the Harvard definition and the critiques offered by Josef Seifert. The Harvard definition, established in 1968, is examined within its medical context, highlighting how it reflects pragmatic interests and raises critical questions about the boundaries between life and death. Seifert’s critiques focus on the reductionist nature of equating personhood with consciousness, emphasizing the need for a broader understanding of life indicators beyond mere physiological functions. The article also discusses the social implications of medicalization in the dying process. Furthermore, it addresses the challenges posed by the cessation of brain function as a criterion for death, contrasting it with more observable signs of life such as breathing and heartbeat. Ultimately, the article argues for a more nuanced understanding of death that incorporates social, cultural, and ethical dimensions, advocating for ongoing dialogue and potential revisions of death definitions to reflect the complexities of human experience. This comprehensive approach aims to bridge the gap between medical definitions and the lived realities of individuals facing death.

Antiplatelet can improve the short-term prognosis of type 2 myocardial infarction caused by acute respiratory failure

Abstract Background Type 2 myocardial infarction (T2MI) is characterized by myocardial infarction resulting from an imbalance between myocardial oxygen supply and demand, without the rupture of acute atherosclerotic plaque. Antiplatelet therapy is the cornerstone of treatment for Type 1 myocardial infarction, however, its efficacy in T2MI remains unclear. Purpose This study aimed to explore the impacts of antiplatelets on prognosis in patients with T2MI caused by acute respiratory failure. Methods The data for this study were derived from the Health and Medical Big Data Superplatform, comprising a retrospective cohort of patients admitted to and discharged from 72 secondary and tertiary hospitals from 2010 to 2023. A total of 4708 patients with T2MI due to acute respiratory failure were included. Participants were divided into two groups: those receiving antiplatelet therapy and those not. T2MI caused by acute respiratory failure was defined as NSTEMI patients caused by respiratory failure without percutaneous coronary intervention (PCI). Propensity score matching (PSM) was used to balance covariates between the groups, followed by building a multivariable Cox regression model to further adjust for potential confounders. Covariates adjusted in multivariable Cox regression included antiplatelet, anticoagulant, and lipid-lowering drug use during hospitalization, age, sex, KILLIP classification, history of diabetes, hypertension, percutaneous coronary intervention, stroke, renal insufficiency, cerebral hemorrhage, and atrial fibrillation. One-to-one matching was performed based on propensity scores using the nearest available pair matching method with a caliper width of 0.01. The primary endpoint was Net Adverse Clinical Events (NACE) within 1 month, including myocardial infarction, cardiac death, stroke and Bleeding Academic Research Consortium (BARC) criteria type 3 or 5. Results Following 1:1 propensity score matching, a total of 1418 participants were enrolled in the final study sample, with 709 patients retained in each group. Patients using antiplatelet were more likely to use ACEI/ARB, CCB, and β-blockers during hospitalization, all p<0.05.Compared to non-antiplatelet therapy group, the use of antiplatelet was associated with a 0.69 times risk of 1-month NACE (aHR, 0.69; p<0.001), a 0.69 times risk of 1-month Major Adverse Cardiovascular and Cerebrovascular Events (MACCE) (aHR, 0.69; p<0.001), a 0.70 times risk of 1-month cardiac death (aHR, 0.70; p<0.001), and a 0.70 times risk of 1-month all-cause mortality (aHR, 0.70; p<0.001); with no statistical significance for other clinical outcomes (p > 0.05) (Figure 1). Conclusions The present study suggested that patients receiving antiplatelet therapy had a lower incidence of one-month NACE, primarily due to a reduction in major cardiac death and MACCE at 1 month.

Developing and Expanding Deceased Organ Donation to its Maximum Therapeutic Potential: An Actionable Global Challenge From the 2023 Santander Summit.

On November 9 and 10, 2023, the Organización Nacional de Trasplantes (ONT), under the Spanish Presidency of the Council of the European Union, convened in Santander a Global Summit entitled "Towards Global Convergence in Transplantation: Sufficiency, Transparency and Oversight." This article summarizes two distinct but related challenges elaborated at the Santander Summit by Working Group 2 that must be overcome if we are to develop and expand deceased donation worldwide and achieve the goal of self-sufficiency in organ donation and transplantation. Challenge 1: the need for a unified concept of death based on the permanent cessation of brain function. Working group 2 proposed that challenge 1 requires the global community to work toward a uniform, worldwide definition of human death, conceptually unifying circulatory and neurological criteria of death around the cessation of brain function and accepting that permanent cessation of brain function is a valid criterion to determine death. Challenge 2: reducing disparities in deceased donation and increasing organ utilization through donation after the circulatory determination of death (DCDD). Working group 2 proposed that challenge 2 requires the global community to work toward increasing organ utilization through DCDD, expanding DCDD through in situ normothermic regional perfusion, and expanding DCDD through ex situ machine organ perfusion technology. Recommendations for implementation are described.

Contributions to the biophilosophical foundations of brain death criterion: an approach from anthropological realism

This article analyzes from a biophilosophical point of view whether it is advisable to adjust the current brain death criteria, according to recent discoveries about brain function. The appropriate foundation for a death criterion is recognizing that a human being is more than his or her physical aspect, within which the brain plays a decisive role. Current neurology states that the brain functions globally. Thus, the irreversible loss of integrated brain activity indicates the end of the irreplaceable function performed by the brain to sustain the unity of the organism. Consequently, the function cessation of the brain-as-a-whole is an adequate adjustment of the brain death criterion. To be recognized as a legitimate criterion from a philosophical point of view and to provide a better framework for the development of laws, the death criterion must presuppose a comprehensive anthropological vision that considers all dimensions of the human being.

Increased mortality among mothers involved in family court care proceedings compared with their peers in England

ObjectiveResearch has called for Family Courts (FC) and social care services involved in removing children from parental care to consider and address the health of the mother. ApproachWe linked England FC and healthcare data to compare the 10-year mortality risk and cause of death after a first live birth (FLB) for mothers who were involved or not in FC proceedings in England. Results3,072,946 mothers (15-39 years) with a FLB between 2007 and 2019 were followed for up to 10 years (median:8.7 years, IQR: 5.4-10), during which 33,759 were involved in FC. Ten-year cumulative mortality was higher among the FC mothers (1.7 vs 0.3%) and the age-adjusted mortality rate ratio was 7.8 (95%CI: 7.00-8.6). The majority of maternal deaths in both groups met criteria for avoidable death (FC 82.9% vs no-FC 66.8%). Injury was the leading cause of death (204/420; 48.5%) in mothers involved in FCs and cancer (2,823/6,208; 45.5%) in mothers in the no-FC group. Compared with no-FC mothers, more deaths were related to drug use (35.0% vs 6.0%), suicide (14.5% vs 8.4%) or alcohol (9.8% vs 3.5%). Among mothers involved in FCs, maternal mortality was higher in cases when children were placed into out-of-home care (1.65%, 463/28143), than when placed at home (0.94%, 53/5563) at first FC proceeding. Conclusions and ImplicationsAddressing high rates of avoidable mortality among mothers involved in FCs is important for children and parents and could be monitored using routinely linked healthcare, social care and family court data.

Possible Heterozygous Hypercholesterolemia Among Adults in Basrah, Southern Iraq.

Background Familial hypercholesterolemia (FH) is an autosomal dominant disease and is one of the most prevalent genetic disorders. We aimed to determine the prevalence of patients with elevated levels of low-density lipoprotein cholesterol (LDL-C), presumptively indicating possible heterozygous familial hypercholesterolemia (HeFH). Methods Retrospective data analysis was conducted for adultpatientsaged 18 and above with fasting LDL-C≥ 190 mg/dL registered in Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC) in Basrah for the period from August 2008 to December 2023. The total number of enrolled individuals was 59,026. Results From the data records of the 59,026 individuals enrolled in the study, it was found that 4,093 (6.9 %)had LDL-C levels ≥190 mg/dLand 361 (0.6 %)had very high total cholesterol according to the Make Early Diagnosis to Prevent Early Death (MEDPED) Criteria. Around 30,527 (51.7 %)were aged 40-59 years, representing the peak age group. Women comprised 34,688 (58.8 %), and 42,310 (71.7 %) had diabetes mellitus. Individuals with obesity comprise27,375 (48.8 %). Out of the 4,093 patients with LDL-C ≥190 mg/dL, 2,422 (59.2 %) were in the 40-59 years age group, and 2,847 (69.6 %) were women. Diabetes was found in 3,442 (84.1 %) patients and obesity in 1,954 (49.9 %) patients. The average blood pressure was higher in the individuals with LDL-C ≥190 (137/83 versus 134/82 respectively, p < 0.001). Conclusions Being one of the largest studies of its kind in the country, the percentage of individuals who might meet the criteria for having possible HeFH in Basrah (Southern Iraq) should raise awareness about the size of the problem in the country, both to encourage family screening programsand to broaden the need for lipid-lowering therapies. Future studies are needed to have further clarifications about the differences in the prevalence between sexes and age groups. These findings need further confirmation by genetic studies including LDL-receptor mutations.

Healthcare Worker Attitudes to Living Donation Prior to Planned Withdrawal of Care.

This study assesses the attitudes of healthcare practitioners toward Living Donation Prior to Planned Withdrawal of Care (LD-PPW): the recovery of a living donor organ before withdrawal of life-sustaining measures in a patient who does not meet criteria for brain death, but for whom medical care toward meaningful recovery is deemed futile. An electronic survey was administered to 1735 members of the American Society of Transplant Surgeons mailing list with 187 responses (10.8%). Data from this study revealed that 70% of responding practitioners agreed with LD-PPW due to principles of beneficence and autonomy. Also, 65% of participants felt confident in their ability to declare the futility of care and 70% felt that LD-PPW should be added as an option when registering to become an organ donor. Currently, nearly half of all donation after circulatory determination of death do not proceed to donation. LD-PPW has been proposed as an alternative procedure targeted at increasing the quality and quantity of transplantable organs while respecting the donor's right to donate, though its implementation has been hindered by concerns over public and provider perception. This study revealed support for LD-PPW among healthcare practitioners as an alternative procedure to increase the quality and quantity of transplantable organs while respecting the donor's right to donate.

Calcineurin Inhibitor in NEuRoloGically deceased donors to decrease kidney delayed graft function study: study protocol of the CINERGY Pilot randomised controlled trial

IntroductionMost solid organ transplants originate from donors meeting criteria for death by neurological criteria (DNC). Within the organ donor, physiological responses to brain death increase the risk of ischaemia reperfusion...

The Unified Brain-Based Determination of Death Conceptually Justifies Death Determination in DCDD and NRP Protocols

Organ donation after the circulatory determination of death requires the permanent cessation of circulation while organ donation after the brain determination of death requires the irreversible cessation of brain functions. The unified brain-based determination of death connects the brain and circulatory death criteria for circulatory death determination in organ donation as follows: permanent cessation of systemic circulation causes permanent cessation of brain circulation which causes permanent cessation of brain perfusion which causes permanent cessation of brain function. The relevant circulation that must cease in circulatory death determination is that to the brain. Eliminating brain circulation from the donor ECMO organ perfusion circuit in thoracoabdominal NRP protocols satisfies the unified brain-based determination of death but only if the complete cessation of brain circulation can be proved. Despite its medical and physiologic rationale, the unified brain-based determination of death remains inconsistent with the Uniform Determination of Death Act.

Causes of Death in Patients Asking for Polyclinic Care for Coronary Heart Disease.

Retrospective analysis of the underlying causes for death of patients who did and did not seek outpatient medical care (OPMC) for ischemic heart disease (IHD), and discussion of a possibility for using administrative anonymized but individualized databases for analysis. The electronic database of the Central Administration of the Civil Registry Office of the Moscow Region (Unified State Register of the Civil Registry Office of the Moscow Region), including medical death certificates (MDC) for 2021, was used to select all cases of fatal outcomes with the disease codes of the International Classification of Diseases, Tenth Revision (ICD-10) (codes of external causes, injuries, poisonings excluded) that were indicated as the primary cause of death (PCD). Personalized data of the deceased were combined with data from electronic medical records of patients who sought OPMC at institutions of the Moscow Region within up to 2 years before death. In addition to IHD, the following PCD codes were taken into account: malignant tumors, COVID-19, diabetes mellitus, cerebrovascular diseases, hypertension, chronic obstructive pulmonary disease, alcohol-associated diseases, and, as examples of unspecified PCD, old age and unspecified encephalopathy.Results In total, among those who died from diseases, the proportion of those who died from IHD was 18.9%; for another 8.4%, IHD was indicated as a comorbid disease in Part II of the MDC. Among those who sought OPMC for IHD, the IHD proportion indicated as PCD was 27.5%, and among those who did not seek OPMC 17.4% (p &lt;0.0001). Those who died from IHD and who had sought OPMC were older (mean age, 75.59 ± 10.94 years) than those who died from IHD and had not sought OMPM (mean age, 73.96 ± 10.94 years; p &lt; 0.0001). The frequency of myocardial infarction as PCD among those who had and had not sought OPMC was the same (12%), chronic forms of IHD were 83.9% and 79.7%, the frequencies of "unspecified" acute forms of IHD (codes I24.8-9) were 4.1% and 8.3%, respectively. The proportion of deaths from COVID-19 was the highest (21.7% and 24.3%, respectively), from malignant neoplasms 11.6% and 12.7%, respectively, and from unspecified encephalopathy 10.6% and 10.7%, respectively. Only 25% of patients who had sought OPMC for IHD died from IHD, otherwise the causes of death were the same as for patients who had not sought OPMC for IHD. Analysis of administrative databases allows identifying disparities in the PCD structure and to direct the efforts of specialists to reconciling the criteria for death from various forms of IHD.

Is Cryocide an Ethically Feasible Alternative to Euthanasia?

While some countries are moving toward legalization, euthanasia is still criticized on various fronts. Most importantly, it is considered a violation of the medical ethics principle of non-maleficence, because it actively seeks a patient's death. But, medical ethicists should consider an ethical alternative to euthanasia. In this article, we defend cryocide as one such alternative. Under this procedure, with the consent of terminally-ill patients, their clinical death is induced, in order to prevent the further advance of their brain's deterioration. Their body is then cryogenically preserved, in the hope that in the future, there will be a technology to reanimate it. This prospect is ethically distinct from euthanasia if a different criterion of death is assumed. In the information-theoretic criterion of death, a person is not considered dead when brain and cardiopulmonary functions cease, but rather, when information constituting psychology and memory is lost.

Criteria for brain death in Denmark

In 1990, the Danish brain death legislation was adopted by the Danish Parliament. Each year, around 100 patients in Denmark fulfil criteria for brain death/death by neurological criteria (BD/DNC). In this review of current Danish criteria including the indication for ancillary investigation, which in Denmark is digital subtraction angiography (DSA), we conclude that the time has come to revise the national BD/DNC criteria. We propose that visible anoxic-ischaemic encephalopathy on brain CT after cardiac arrest does not require evaluation by ancillary testing, and that CT-angiography can be used instead of DSA.

Editors' Note: What Is the Ideal Brain Criterion of Death? Nonclinical Considerations: The UDDA Revision Series.

Editors' Note: What Is the Ideal Brain Criterion of Death? Nonclinical Considerations: The UDDA Revision Series.

Reader Response: What Is the Ideal Brain Criterion of Death? Nonclinical Considerations: The UDDA Revision Series.

Reader Response: What Is the Ideal Brain Criterion of Death? Nonclinical Considerations: The UDDA Revision Series.

Author Response: What Is the Ideal Brain Criterion of Death? Nonclinical Considerations: The UDDA Revision Series.

Author Response: What Is the Ideal Brain Criterion of Death? Nonclinical Considerations: The UDDA Revision Series.

СОВРЕМЕННЫЙ ПОДХОД К ОЦЕНКЕ ПЕРИНАТАЛЬНОГО РИСКА, ОСНОВАННЫЙ НА ИСПОЛЬЗОВАНИИ ПРОГНОСТИЧЕСКИХ КРИТЕРИЕВ АНТЕНАТАЛЬНЫХ, ИНТРАНАТАЛЬНЫХ И РАННИХ НЕОНАТАЛЬНЫХ ПОТЕРЬ

The problem of perinatal losses is still actual in obstetrics today. At the same time there are cases of non-estimation or extra-estimation of perinatal risk in obstetrical practice. The usage of famous prognostic systems gives the opportunity to select pregnant women into groups of high risk and provide the necessary organizational and tactic measures. But to define the character of possible complications, to establish the degree of their severity and time of appearance is really impossible. Objective of the study: to develop a new approach to estimation of perinatal risk based on the determination of prognostic criteria for antepartum and intrapartum fetal death, early neonatal death of a newborn in order to increase the efficacy of predicting of unfavourable perinatal outcomes. Materials and research methods. The retrospective case-control study in patients with antepartum (n=134) and intrapartum (n=41) fetal death, early neonatal death of the newborn (n=61) and favourable perinatal outcome (n=50) was conducted. There was used the Bayes algorhythm with Wald's consecutive analysis in the modification of Genkin-Gubler to determine prognostic criteria. The comparative estimation of the efficacy of the proposed prognostic method and traditional method of determining perinatal risk was performed retrospectively in patients with perinatal losses (n=102) and favourable perinatal outcome (n=100). ROC analysis was performed. Results. There were identified 42 risk factors divided into three groups: universal for all types of perinatal losses, common for two of them and specific for each of them (antepartum and intrapartum fetal death, early neonatal death of a newborn). There was determined the prognostic influence of factors in their presence and absence. It was found that universal and common risk factors had different prognostic influence for each type of perinatal losses. There was presented the method for differential predicting of perinatal losses. The sensitivity of the new and traditional prognostic methods was 95.1% and 69.6%, specificity was 80% and 53%, and the accuracy of predicting of unfavourable outcome was 87.6% and 61.4% respectively. Conclusion. The investigation permitted to propose the new approach to estimation of perinatal risk, based on differential predicting of perinatal losses being is more effective than traditional method in predicting adverse perinatal outcomes.

Sowing “seeds of trust”: How trust in normothermic regional perfusion is built in a continuum of care

Normothermic regional perfusion (NRP) is a promising technology to improve organ transplantation outcomes by reversing ischemic injury caused by controlled donation after circulatory determination of death. However, it has not yet been implemented in Canada due to ethical questions. These issues must be resolved to preserve public trust in organ donation and transplantation. This qualitative, constructivist grounded theory study sought to understand how those most impacted by NRP perceived the ethical implications. We interviewed 29 participants across stakeholder groups of donor families, organ recipients, donation and transplantation system leaders, and care providers. The interview protocol included a short presentation about the purpose of NRP and procedures in abdomen versus chest and abdomen NRP, followed by questions probing potential violations of the dead donor rule and concerns regarding brain reperfusion. The results present a grounded theory placing NRP within a trust-building continuum of care for the donor, their family, and organ recipients. Stakeholders consistently described both forms of NRP as an ethical intervention, but their rationales were predicated on assumptions that neurologic criteria for death had been met following circulatory death determination. Empirical validation of these assumptions will help ground the implementation of NRP in a trust-preserving way.

Role of high-volume plasmapheresis in the management of paediatric acute liver failure.

Paediatric acute liver failure (PALF) is a life-threatening disease. Management aims to support hepatic regeneration or to bridge to liver transplantation. High-volume plasmapheresis (HVP) removes protein-bound substances, alleviates inflammation, and improves survival in adult acute liver failure. However, experience with HVP in PALF is limited. Aim of this study is to report on feasibility, safety, efficacy and outcomes of HVP in PALF. Retrospective observational study in children with PALF. HVP was performed upon identification of negative prognostic indicators, in toxic aetiology or multiorgan failure (MOF). Exchanged volume with fresh-frozen plasma corresponded to 1.5-2.0 times the patient's estimated plasma volume. One daily cycle was performed until the patient met criteria for discontinuation, that is, liver regeneration, liver transplantation, or death. Twenty-two children with PALF (body weight 2.5-106 kg) received 1-7 HVP cycles. No bleeding or procedure-related mortality occurred. Alkalosis, hypothermia and reduction in platelets were observed. Haemolysis led to HVP termination in one infant. Seven children (32%) survived with their native livers, 13 patients (59%) underwent liver transplantation. Two infants died due to MOF. Overall survival was 86%. International normalization ratio (INR), alanine aminotransaminases (ALT), bilirubin and inotropic support were reduced significantly (p < 0.05) after the first HVP-cycle (median): INR 2.85 versus 1.5; ALT 1280 versus 434 U/L; bilirubin 12.7 versus 6.7 mg/dL; norepinephrine dosage 0.083 versus 0.009 µg/kg/min. Median soluble-interleukin-2-receptor dropped significantly following HVP (n = 7): 2407 versus 950 U/mL (p < 0.02). HVP in PALF is feasible, safe, improves markers of liver failure and inflammation and is associated with lowering inotropic support. Prospective and controlled studies are required to confirm efficacy of HVP in PALF.