Criteria For Death Research Articles

Reflex and Spontaneous Movements in Pediatric Patients with Brain Death.

Reflex and spontaneous movements are not uncommon in brain death patients. However, most studies have been conducted in adults, while reports in infants and children are rare. Thus, we aimed to evaluate the frequency and characteristics of these movements in pediatric patients declared as brain death. Records of pediatric patients who were diagnosed as brain death from 15 hospitals in the Yeongnam region, South Korea, between January 2013 and September 2016 were analyzed. All body movements in patients who met the criteria for brain death as established by the Korea Medical Association were assessed by medical doctors and trained organ transplant coordinators. The frequency and characteristics of these movements were identified. Additionally, the demographic and clinical factors of the brain death patients with and without these movements were compared. A total of 31 patients who met the criteria for brain death were enrolled. Seven patients (22.6%) showed either reflex or spontaneous movements; six of them (85.7%) showed reflex movements only, and one patient (14.3%) showed both types of movements. The most common types of reflex movements were the flexor/extensor plantar response and isolated finger jerk. Four of seven patients (57.1%) showed a single movement pattern, while three (42.9%) showed two different movement patterns. It is essential for physicians who perform pediatric brain death examinations to recognize the frequency and characteristics of reflex and spontaneous movements, and this article may help in the accurate and prompt diagnosis of brain death.

Reflex and Spontaneous Movements in Pediatric Patients with Brain Death

Reflex and spontaneous movements are not uncommon in brain death patients. However, most studies have been conducted in adults, while reports in infants and children are rare. Thus, we aimed to evaluate the frequency and characteristics of these movements in pediatric patients declared as brain death. Records of pediatric patients who were diagnosed as brain death from 15 hospitals in the Yeongnam region, South Korea, between January 2013 and September 2016 were analyzed. All body movements in patients who met the criteria for brain death as established by the Korea Medical Association were assessed by medical doctors and trained organ transplant coordinators. The frequency and characteristics of these movements were identified. Additionally, the demographic and clinical factors of the brain death patients with and without these movements were compared. A total of 31 patients who met the criteria for brain death were enrolled. Seven patients (22.6%) showed either reflex or spontaneous movements; six of them (85.7%) showed reflex movements only, and one patient (14.3%) showed both types of movements. The most common types of reflex movements were the flexor/extensor plantar response and isolated finger jerk. Four of seven patients (57.1%) showed a single movement pattern, while three (42.9%) showed two different movement patterns. It is essential for physicians who perform pediatric brain death examinations to recognize the frequency and characteristics of reflex and spontaneous movements, and this article may help in the accurate and prompt diagnosis of brain death.

Prognosis value of Forrester's classification in advanced heart failure patients awaiting heart transplantation.

The value of Forrester's perfusion/congestion profiles assessed by invasive catheter evaluation in non-inotrope advanced heart failure patients listed for heart transplant (HT) is unclear. We aimed to assess the value of haemodynamic evaluation according to Forrester's profiles to predict events on the HT waitlist. All non-inotrope patients (n=837, 79% ambulatory at listing) registered on the French national HT waiting list between 1 January 2013 and 31 December 2019 with right heart catheterization (RHC) were included. The primary outcome was a combined criteria of waitlist death, delisting for aggravation, urgent HT or left ventricular assist device implantation. Secondary outcome was waitlist death. The 'warm-dry', 'cold-dry', 'warm-wet', and 'cold-wet' profiles represented 27%, 18%, 27%, and 28% of patients, respectively. At 12months, the respective rates of primary outcome were 15%, 17%, 25%, and 29% (P=0.008). Taking the 'warm-dry' category as reference, a significant increase in the risk of primary outcome was observed only in the 'wet' categories, irrespectively of 'warm/cold' status: hazard ratios, 1.50; 1.06-2.13; P=0.024 in 'warm-wet' and 1.77; 1. 25-2.49; P=0.001 in 'cold-wet'. Haemodynamic assessment of advanced HF patients using perfusion/congestion profiles predicts the risk of the combine endpoint of waitlist death, delisting for aggravation, urgent heart transplantation, or left ventricular assist device implantation. 'Wet' patients had the worst prognosis, independently of perfusion status, thus placing special emphasis on the cardinal prominence of persistent congestion in advanced HF.

PANoptosis: new insights in regulated cell death in ischemia/reperfusion models.

PANoptosis: new insights in regulated cell death in ischemia/reperfusion models.

Cases Abusing Brain Death Definition in Organ Procurement in China.

Organ donation after brain death has been practiced in China since 2003 in the absence of brain death legislation. Similar to international standards, China's brain death diagnostic criteria include coma, absence of brainstem reflexes, and the lack of spontaneous respiration. The Chinese criteria require that the lack of spontaneous respiration must be verified with an apnea test by disconnecting the ventilator for 8min to provoke spontaneous respiration. However, we have found publications in Chinese medical journals, in which the donors were declared to be brain dead, yet without an apnea test. The organ procurement procedures started with initiating "intratracheal intubation for mechanical ventilation after brain death," indicating that a brain death diagnosis was not performed. The purpose of the intubation was not to resuscitate the patient but rather was directly related to facilitating the explantation of organs. Moreover, it was unmistakably stated in two of these publications that the cardiac arrest was induced in these patients without brain death determination by cold St. Thomas cardioplegic solution or other cold myocardial protection solutions. This means that the condition of these donors neither met the criteria of brain death nor that of cardiac death. In other words, the "donor organs" may well have been procured in these cases from living human beings. Thus, brain death definition is abused in China by some individuals for organ harvesting, and a systematic investigation is needed to clarify the situation of organ donation after brain death in China.

Brain death debates: from bioethics to philosophy of science.

50 years after its introduction, brain death remains controversial among scholars. The debates focus on one question: is brain death a good criterion for determining death? This question has been answered from various perspectives: medical, metaphysical, ethical, and legal or political. Most authors either defend the criterion as it is, propose some minor or major revisions, or advocate abandoning it and finding better solutions to the problems that brain death was intended to solve when it was introduced. Here I plead for a different approach that has been overlooked in the literature: the philosophy of science approach. Some scholars claim that human death is a matter of fact, a biological phenomenon whose occurrence can be determined empirically, based on science. We should take this claim seriously, whether we agree with it or not. The question is: how do we know that human death is a scientific matter of fact? Taking the philosophy of science approach means, among other things, examining how the determination of human death became an object of scientific inquiry, exploring the nature of the brain death criterion itself, and analysing the meaning of its core concepts such as "irreversibility" and "functions".

Association of CABG SYNTAX score with long term clinical outcomes in patients with acute myocardial infarction undergoing SVG PCI.

The CABG SYNTAX score (CSS) has been recommended as an objective and quantitative evaluation tool for coronary anatomic complexity after CABG. We aimed at evaluating the long-term prognostic value of the CSS and its relationship with the composite criteria of all-cause death, cerebrovascular accident (CVA) and/or non-fatal myocardial infarction (MI) in patients who underwent percutaneous coronary intervention (PCI) of saphenous vein graft (SVG). We retrospectively evaluated 232 patients who were admitted with MI and underwent PCI of SVGs, between 2012 and 2018. The study population was divided into two groups according to the results of the median pre-PCI CSS. The composite criteria of all-cause death/CVA/non-fatal MI were observed in 107 patients (46.1%). The incidence of the primary endpoint was significantly higher among the patients with a high pre-PCI CSS (p < .001). Multivariable Cox regression analyses demonstrated that both pre-PCI CSS (HR = 1.678, 95% CI = 1.082-2.602, p = .021) and post-PCI CSS (HR = 1.663, 95% CI = 1.066-2.596, p = .025) were significantly associated with the primary endpoint. The Kaplan-Meier cumulative curves divided by the median of the pre-PCI CSS demonstrated that, compared with the low pre-PCI CSS group, the high-score group was associated at five years with higher composite criteria of all-cause death/CVA/non-fatal MI (low, 40.3%; high, 57.8%; p = .015). Pre-PCI CSS is a significant prognostic factor for the long-term clinical outcomes in patients with previous CABG who underwent PCI of SVG.

Brain death debates: from bioethics to philosophy of science

50 years after its introduction, brain death remains controversial among scholars. The debates focus on one question: is brain death a good criterion for determining death? This question has been answered from various perspectives: medical, metaphysical, ethical, and legal or political. Most authors either defend the criterion as it is, propose some minor or major revisions, or advocate abandoning it and finding better solutions to the problems that brain death was intended to solve when it was introduced. Here I plead for a different approach that has been overlooked in the literature: the philosophy of science approach. Some scholars claim that human death is a matter of fact, a biological phenomenon whose occurrence can be determined empirically, based on science. We should take this claim seriously, whether we agree with it or not. The question is: how do we know that human death is a scientific matter of fact? Taking the philosophy of science approach means, among other things, examining how the determination of human death became an object of scientific inquiry, exploring the nature of the brain death criterion itself, and analysing the meaning of its core concepts such as “irreversibility” and “functions”.

Factors Influencing Survival Outcome in Deceased Renal Transplant Recipients

Background: Renal replacement therapy is the gold standard treatment of end-stage renal disease. Since the number of cases of chronic kidney diseases are increasing exponentially in our country, only live-related transplant is not enough to bridge the gap between disease and their treatment which increased the demand for deceased renal transplant program in our country. Objective: The objective is to study donors and recipients' characteristics for association with survival of patients in deceased renal allograft transplant. Materials and Methods: It is an ambispective observational analysis of 42 deceased donor renal transplants performed in our institute from January 2012 to December 2019. The difference among donors and recipients' characteristics was analyzed for association with the outcome for survival or death of the patient. Statistical analysis was done using SSPS 21.0 software and P value &lt; 0.05 was taken as statistically significant. Results: In association with survival and expired outcomes, donors and recipients age, donors sex, cause of brain death (traumatic/nontraumatic), standard or extended criteria of donor, serum creatinine at the time of death, dialysis vintage period, warm and cold ischemia time, duration of hospital stay had shown no significant association with survival. While donors' urine output at the time of death, recipients sex, previous sensitization of recipients either by previous episodes of blood transfusion or pregnancy, achievement of normal renal function at day 14 of transplant, and tacrolimus level at 1 month of transplant shown significant association with the outcome. Conclusion: Deceased donors' characteristics, mainly urine output at death, recipients characteristic, namely any previous sensitization, achievement of normal renal function at day 14, serum tacrolimus level at 1-month posttransplant have a significant association with survival of deceased renal allograft transplant recipients. Sepsis and severe acidosis were the main complications contributing to mortality.

The brain during life and in adjudicating death: Reduced brain identity of persons as a critique of the neurological criteria of death.

The determination of death by neurological criteria (brain death) is practiced in at least 80 countries, though it is a matter of continuing controversy. At the same time, the brain is central to human life, thinking, and behavior; however, a growing "neurocentrism" or a brain-focused image of human identity became established in most Western and in many non-Western societies and acts as a forceful ideology. This paper seeks a broader theoretical and sociocultural basis to approaching death bioethically by analyzing criticisms aimed at a neurologically focussed vision of human life, and then turning these towards the brain death criteria exposed to the criticism. The overall critique of the "neuro-self" has scope to offer alternative perspectives to the contested issues in brain-death criteria. Specifically, the paper examines two major shortcomings of a narrow brain view of life and culture. First, it considers the reduction of the individual to the brain: this is the crux of the neurological way of determining death, and is a way that is seemingly context-independent and culturally neutral. Second, it considers how dimensions of society and culture for humans are detached from the brain and have little impact on clinical practice and thinking in brain-death criteria; however, a deeper exploration reveals that they actually have direct relevance and that social and cultural factors have greater contributions to make to the current debates.

Healthcare Professionals' Understandings of the Definition and Determination of Death: A Scoping Review.

Background.During the 1950s, advances in critical care, and organ transplantation altered the relationship between organ failure and death. There has since been a shift away from traditional cardiocirculatory based to brain-based criteria of death, with resulting academic controversy, despite the practice being largely accepted worldwide. Our objective is to develop a comprehensive description of the current understandings of healthcare professionals regarding the meaning, definition, and determination of death.Methods.Online databases were used to identify papers published from 2003 to 2020. Additional sources were searched for conference proceedings and theses. Two reviewers screened papers using predefined inclusion and exclusion criteria. Complementary searches and review of reference lists complemented the final study selection. A data extraction instrument was developed to iteratively chart the results of the review. A qualitative approach was conducted to thematically analyze the data.Results.Seven thousand four hundred twenty-eight references were identified. In total, 75 papers met the inclusion criteria. Fourteen additional papers were added from complementary searches. Most were narratives (35%), quantitative investigations (21%), and reviews (18%). Identified themes included: (1) the historical evolution of brain death (BD), (2) persistent controversies about BD and death determination, (3) wide variability in healthcare professionals’ knowledge and attitudes, (4) critical need for BD determination revision.Conclusions.We concluded that although BD is widely accepted, there exists variation in healthcare providers’ understanding of its conceptual basis. Death determination remains a divisive issue among scholars. This review identified a need for increased opportunities for formal training on BD among healthcare providers.

Brain Death, the Soul, and Material Dispositions

Abstract I defend the position argued previously by Germain Grisez and me that total brain death is a valid criterion of death on the grounds that a human being is essentially a rational animal, and a brain-dead body lacks the radical capacity for rational actions. I reply to Josef Seifert’s objection that our positions rest on a reductionist view of the human person, and to other objections concerning the inter-relation between the human soul, its powers, and functions of the brain. I argue that a brain-dead body lacks the material dispositions needed for having the form or soul of a human being.

Brain death debates: from bioethics to epistemology.

50 years after its introduction, brain death remains controversial among scholars. The debates focus on one question: is brain death a good criterion for determining death? This question has been answered from various perspectives: medical, metaphysical, ethical, and legal or political. Most authors either defend the criterion as it is, propose some minor or major revisions, or advocate abandoning it and finding better solutions to the problems that brain death was intended to solve when it was introduced. In short, debates about brain death have been characterized by partisanship, for or against. Here I plead for a non-partisan approach that has been overlooked in the literature: the epistemological or philosophy of science approach. Some scholars claim that human death is a matter of fact, a biological phenomenon whose occurrence can be determined empirically, based on science. We should take this claim seriously, whether we agree with it or not. The question is: how do we know that human death is a scientific matter of fact? Taking the epistemological approach means, among other things, examining how the determination of human death became an object of scientific inquiry, exploring the nature of the brain death criterion itself, and analysing the meaning of its core concepts such as "irreversibility" and "functions".

Ischemic heart disease: medical certificate of cause of death analysis

Aim. According to data from the Moscow Oblast civil registry office in 2020, to analyze medical certificates of cause of death (MCCD), where the code from “Ischemic heart disease” (IHD) (I20-I25) group is indicated as underlying cause of death (UCD).Material and methods. A total of 23193 deaths with I20-I25 codes (UCDs) were included. We assessed the prevalence of individual IHD types, the frequency and patterns of complications, the average age of deceased persons, the proportion of women and men, place of death registration.Results. The average age of the deceased was 73,6±12,5 (men, 68,8±10,5; women, 78,4±12,5; p&lt;0,0001). The proportion of women who died under the age of 70 was &lt;20%, men — &gt;50%. Half of the deaths were registered at home, a third in a hospital, and the rest elsewhere. Taking into account age and sex, inhospital death from myocardial infarction (MI) is recorded 12 times more often than in “other forms of acute IHD”. Chronic forms of IHD were registered in 76,9% of cases; in 47,3%, such IHD form as “Atherosclerotic heart disease” was noted. The proportion of deaths from acute MI and deaths after MI was 37,3%. In 92,1% of MCCDs of “other forms of acute IHD”, “acute coronary insufficiency” is indicated. Differences in the prevalence of various IHD forms between men and women were significant (p&lt;0,0001). In female mortality pattern, there are 3 times less deaths from other (non-MI) acute forms of IHD and almost 2 times less deaths from old myocardial infarction and cardiac aneurysm. As the immediate cause of death, heart failure was indicated in 78,9%, while among those with prior MI — in 91%. In other acute forms of IHD, acute coronary insufficiency was indicated in 89%.Conclusion. A high proportion of deaths with unspecified acute and chronic forms of IHD as the cause of death, especially in young men, requires a comprehensive study and development by the Russian Society of Cardiology of criteria for death from various IHD forms.

Familial Hypercholesterolemia Prevalence Among Ethnicities-Systematic Review and Meta-Analysis.

Background: Heterozygous familial hypercholesterolemia (FH) is a common genetic disorder leading to premature cardiovascular disease and death as a result of lifelong high plasma low-density lipoprotein cholesterol levels, if not treated early in life. The prevalence of FH varies between countries because of founder effects, use of different diagnostic criteria, and screening strategies. However, little is known about differences in FH prevalence according to ethnicity. We aimed to investigate the ethnic distribution of FH in diverse populations and estimate the prevalence of FH according to ethnicity. Methods: We performed a systematic review and meta-analysis, searching PubMed and Web of Science for studies presenting data on the prevalence of heterozygous FH among different ethnicities in non-founder populations. Studies with more than 100 individuals, relevant data on prevalence, ethnicity, and using the Dutch Lipid Clinical Network Criteria, Simon Broome, Making Early Diagnosis Prevents Early Death, genetic screening, or comparable diagnostic criteria were considered eligible for inclusion. Results: Eleven general population studies and two patient studies were included in a systematic review and 11 general population studies in a random-effects meta-analysis. The overall pooled FH prevalence was 0.33% or 1:303 in 1,169,879 individuals (95% confidence interval: 0.26–0:40%; 1:385–1:250). Included studies presented data on six ethnicities: black, Latino, white, Asian, brown, and mixed/other. Pooled prevalence was estimated for each group. The highest prevalence observed was 0.52% or 1:192 among blacks (0.34–0.69%; 1:294–1:145) and 0.48% or 1:208 among browns (0.31–0.74%; 1:323–1:135) while the lowest pooled prevalence was 0.25% or 1:400 among Asians (0.15–0.35; 1:500–1:286). The prevalence was 0.37% or 1:270 among Latino (0.24–0.69%; 1:417–1:145), 0.31% or 1:323 among white (0.24–0.41%; 1:417–1:244), and 0.32% or 1:313 among mixed/other individuals (0.13–0.52%; 1:769–1:192). Conclusion: The estimated FH prevalence displays a variation across ethnicity, ranging from 0.25% (1:400) to 0.52% (1:192), with the highest prevalence seen among the black and brown and the lowest among the Asian individuals. The differences observed suggest that targeted screening among subpopulations may increase the identification of cases and thus the opportunity for prevention.

Current state and future direction of task shifting in obstetric and gynecological care: A survey of obstetrician-gynecologists across Japan.

To conduct a survey about task shifting in obstetric and gynecological care.A multivariate logistic regression analysis was conducted in Japanese hospitals using obstetrician–gynecologists (OB/GYNs) who answered that task shifting was rarely used at their working environment as the outcome variable and using their personal attributes (sex, age, type of medical institution employed at, and regional characteristics) as predictor variables. Opinions were gathered regarding promoting task shifting impact on individual work duties.Responses were collected from 919 OB/GYNs (49.9% women, 50.8% <40 years). Characteristics’ analysis of 34.6% of OB/GYNs who thought that task shifting was hardly used indicated that it was used significantly more at private university hospitals (odds ratio 5.33, 95% confidence interval: 2.33–12.18) than at national university hospitals (odds ratio 3.54, 95% confidence interval: 1.67–7.51). “Transfer of patients (from operating rooms to the ward)” and “securing the contrast agent line” were the only items related to the task shifting status for individual work duties that were identified by most respondents, revealing that task shifting is not progressing. More than half and 9% of the OB/GYNs said that task shifting progression would improve and decline medical care quality, respectively. Overall, 46% and 24% of the respondents thought that task shifting could reduce working hours by “>1 hour, but <2 hours”/day and “<1 hour”/day, respectively.The current study confirmed that OB/GYNs working at university hospitals believe that task shifting is not progressing in university hospitals and that the working environment is poor. Even if task shifting reduces the number of working hours per day by 2 hours, the working hours of these physicians still exceed the criteria for death by overwork. Thus, further working hour reduction measures are needed in addition to task shifting, such as consolidation of medical institutions dealing with deliveries.To promote task shifting in obstetrical and gynecological care in Japan, it is necessary to continue promoting policy-based, institutional, and educational guidance.

Perception of Brazilian medical students toward organ donation.

Brazil ranks second in gross numbers of kidney and liver transplantations, but deceased organ donation is still far below the national demand for organs. Apart from a high family refusal rate, another significant barrier is healthcare workers' inappropriate knowledge concerning organ donation and transplantation. Since most of them have recently graduated from university, this study aimed to evaluate the awareness and attitudes of medical students concerning organ donation. Between August and September 2021, a web-based survey with 10 overlapping questions was sent to medical students from several Brazilian universities after advertisements on social media. A total of 391 (60% female, mean age: 23 [17-41] years) students answered the survey. Most of them (91%) would like to donate organs in case of death, and 75% have already notified their family. The main reasons for not becoming a donor were fear of body manipulation (n=3) or family reaction (n=2) and religious reasons (n=2). When inquired, 54% were unaware of brain death criteria, and half of them claimed to have never discussed the topic in medical classes. Except for Glasgow coma scale (97%), pupillary (72%), and corneal (53%) reflexes, less than 25% knew other reflexes required for brain death diagnosis. Most medical students declared themselves as organ donors, and most informed their families. However, many students have never learned about crucial steps toward organ donation, which may impact their adequate recognition of potential organ donors later in life.

Application of Mesenchymal Stem Cells During Machine Perfusion: An Emerging Novel Strategy for Organ Preservation.

Although solid organ transplantation remains the definitive management for patients with end-stage organ failure, this ultimate treatment has been limited by the number of acceptable donor organs. Therefore, efforts have been made to expand the donor pool by utilizing marginal organs from donation after circulatory death or extended criteria donors. However, marginal organs are susceptible to ischemia-reperfusion injury (IRI) and entail higher requirements for organ preservation. Recently, machine perfusion has emerged as a novel preservation strategy for marginal grafts. This technique continually perfuses the organs to mimic the physiologic condition, allows the evaluation of pretransplant graft function, and more excitingly facilitates organ reconditioning during perfusion with pharmacological, gene, and stem cell therapy. As mesenchymal stem cells (MSCs) have anti-oxidative, immunomodulatory, and regenerative properties, mounting studies have demonstrated the therapeutic effects of MSCs on organ IRI and solid organ transplantation. Therefore, MSCs are promising candidates for organ reconditioning during machine perfusion. This review provides an overview of the application of MSCs combined with machine perfusion for lung, kidney, liver, and heart preservation and reconditioning. Promising preclinical results highlight the potential clinical translation of this innovative strategy to improve the quality of marginal grafts.

Donation after cardiac death in heart transplantation: is there an ethical dilemma?

In an attempt to address the organ shortages in heart transplantation, USA centres have begun utilizing donation after cardiac death (DCD) as an alternative to traditional donation after brain death (DBD). As this paradigm continues to expand, there is a need to address the medico-legal and ethical aspects of DCD donation, which is the focus of the current review. Current protocols use criteria established by the Uniform Determination of Death Act (UDDA), which is explicit in defining the irreversibility of circulation and brain function in determining death. By the nature of DCD, the patient may not meet death criteria from a biological systems perspective of irreversibility, and thus, the moral dilemma ensues on whether removing vital organs violates our legal and moral obligations to the patient. In the current article, we review the ethical issues raised with DCD and define DCD protocols and their ability to comply with established regulatory guidelines while respecting the wishes of patients and their surrogates through informed decisions making about organ donation and end-of-life care.

Liver Transplantation in Malaysia: Needs, Obstacles, and Opportunities.

Liver Transplantation in Malaysia: Needs, Obstacles, and Opportunities.