History Of Brain Death Research Articles

Computed Tomography Perfusion for the Diagnosis of Brain Death: A Technical Review.

Timely diagnosis of brain death (BD) is critical as it prevents unethical and futile continuation of support of vital organ functions when the patient has passed. Furthermore, it helps with avoiding the unnecessary use of resources and provides early opportunity for precious organ donation. The diagnosis of BD is mainly based on careful neurological assessment of patients with an established underlying diagnosis of neurological catastrophe capable of causing BD.Ancillary testing, however, is tremendously helpful in situations when the presence of confounders prevents or delays comprehensive neurological assessment. Traditionally, four-vessel digital subtraction angiography and computed tomography angiography have been used for blood flow (BF) examinations of the brain. The lack of BF in the intracranial arteries constitutes conclusive evidence that the brain is dead. However, there is an apparent discrepancy between the BF and sufficient cerebral perfusion; several studies have shown that in 15% of patients with confirmed clinical diagnosis of BD, BF is still preserved. In these patients, cerebral perfusion is significantly impaired. Hence, measurement of cerebral perfusion rather than BF will provide a more precise assessment of the brain function.In this review article, we discuss a brief history of BD, our understanding of its complex pathophysiology, current Canadian guidelines for the clinical diagnosis of BD, and the ancillary tests-specifically CT perfusion of the brain that help us with the prompt and timely diagnosis of BD.

The obstacles to organ donation following brain death in Iran: a qualitative study

BackgroundOrgan donation following brain death has become an important way of supplying organs for transplantation in many countries. This practice is less common in Iran for different reasons. Therefore, this study aims to explore the obstacles to organ donation following brain death in Iran.MethodsThis qualitative research was conducted following the conventional content analysis method. The study population consisted of individuals with a history of brain death among their blood relatives who refused to donate the organs. Snowball sampling was employed to select the participants. In-depth semi-structured interviews were conducted for data gathering. Theoretical saturation was achieved through 20 interviews. Data analysis was done following the steps proposed by Graneheim and Lundman. Lincoln and Guba’s criteria were used to ensure data rigor and transferability of the study.ResultsData analyses revealed 185 codes, 23 categories, and seven themes including, poor knowledge about brain death and organ transplantation from a dead body, cultural beliefs, religious beliefs, deficiencies of requesting process, fear and concerns, inability to make a decision, and social learning.ConclusionThere were several factors in families’ reluctance to donate organs of a brain-dead patient. Through improving knowledge and changing cultural beliefs in society, it is possible to take large steps towards promoting organ donation from brain-dead patients.

Defending a Functionalist View of Higher Brain Death

We provide a brief overview of the history of brain death showing how the cardiopulmonary model (CPM) of death became problematic due to the technological innovation of mechanical ventilation beginning with its use in the 1950s. We then examine difficulties that emerged with what was to become the received view of brain death known as Whole Brain Death (WBD). We argue that these challenges were never satisfactorily met by defenders of WBD. We also argue that a return to a CPM leads to even greater conceptual difficulties. Given that there are serious difficulties with both WBD and the CPM, we introduce a new version of higher brain death which we refer to as a functionalist view. We argue that a functionalist view of higher brain death can be defended more consistently than WBD and the CPM. Our defense introduces the notion of basing death on mental processing as opposed to traditional notions of higher brain death which used problematic and imprecise concepts such as consciousness and personhood.

History of brain death as death: 1968 to the present

The concept of brain death was formulated in 1968 in the landmark report A Definition of Irreversible Coma. While brain death has been widely accepted as a determination of death throughout the world, many of the controversies that surround it have not been settled. Some may be rooted in a misconstruction about the history of brain death. The concept evolved as a result of the convergence of several parallel developments in the second half of the 20th century including advances in resuscitation and critical care, research into the underlying physiology of consciousness, and growing concerns about technology, medical futility, and the ethics of end of life care. Organ transplantation also developed in parallel, and though it clearly benefited from a new definition of death, it was not a principal driving force in its creation. Since 1968, the concept of brain death has been extensively analyzed, debated, and reworked. Still there remains much misunderstanding and confusion, especially in the general public. In this comprehensive review, I will trace the evolution of the definition of brain death as death from 1968 to the present, providing background, history and context.

Brain Death: Can It Be Resuscitated?

Why is a patient with a destroyed considered dead rather than moribund and irreversibly comatose? The world has been grappling with this question for the past four decades with little success. The recently released white paper of the President's Council on Bioethics is in many respects a refreshing, thoughtful, and comprehensive reexamination of this complex topic. (1) It offers a very helpful analysis of the major positions on the determination of death, and it proffers a creative new solution of its own. Unfortunately, the new solution does not put the problem to rest, but the humility with which the council discusses its own position and the honesty with which it confronts the consequences of being wrong alone make this report a very commendable document. Historical Backdrop What is refreshing about the white paper emerges best when it is put in historical perspective. In 1968, the Harvard Committee catalyzed a monumental socio-medico-legal revolution: the reformulation of in terms of function. (2) The only rationale given by the committee for why the irreversible cessation of all functions should be equated with was legal utility: it would free up beds in intensive care units and facilitate organ transplantation. The Harvard report ushered in a brief era of wild transplantation. (3) In a domino effect beginning in 1970, state after state revised its statutory definition of death, despite the absence not just of official diagnostic criteria for irreversible cessation of all functions, but also of any generally accepted philosophical rationale for why irreversible nonfunction of the should constitute death. By 1978, over thirty different diagnostic criteria had been published, none of them validated; neither had any consensus on the conceptual basis emerged. (4) The next milestone in the history of brain death was the 1981 President's Commission. (5) Its comprehensive report included a proposed Uniform Determination of Death Act (UDDA), which served as the model for the remaining twenty-three states that had not yet revised their statutes to include a brain-based criterion. Its medical consultants proposed a set of diagnostic criteria that instantly became the standard for the United States. And most importantly, it articulated a then-plausible rationale for equating irreversible cessation of all function with death--namely, the loss of integrative unity of the organism. It argued that the is the body's central integrator, without which the body necessarily and imminently literally dis-integrates and succumbs to asystole despite all technological interventions. The President's Commission also maintained that brain death and ordinary are physiologically identical states, only in the former case the equivalence is masked by artificial ventilation and circulatory support. That same year, James Bernat, Charles Culver, and Bernard Gert published an influential paper promoting even more forcefully the integrative unity rationale, which quickly became the mainstream conceptual justification for in the United States and many other countries. (6) Over the next two decades, however, new clinical data made it increasingly clear that patients with total failure were not physiologically identical to non-heart-beating corpses, and they did not necessarily dis-integrate despite all technological support. Moreover, the rare longer-surviving ones exhibited holistic properties such as homeostasis, proportional growth (of a child), teleological repair, and general ability to survive outside a hospital setting with relatively little support (ventilator, tube feedings, and nursing care-much less than many sick patients in intensive care units require, who are nevertheless clearly living organisms). Such properties are difficult to reconcile with the mainstream assumption that these bodies were nothing but bags of partially interacting subsystems. …