Friday, January 18, 2019

Fifty years of "brain death"

There was a time when death came in threes: neurological, respiratory, and circulatory processes all shut down more or less together, because when a body lost one of these the others inevitably followed very quickly.  But what makes most deceased organ transplantation possible is that respiration and circulation can be maintained on a ventilator after the end of neurological activity, so that organs can remain oxygenated after the brain has died.

The Uniform Determination of Death Act (UDDA) states that an individual who has sustained either:
"an irreversible cessation of circulatory and respiratory functions, or
an irreversible cessation of all functions of the entire brain, including the brain stem, is dead."

A recent Hastings Center Report discusses brain death on the 50th anniversary of its 'birth'.

Brain Death at Fifty: Exploring Consensus, Controversy, and Contexts
Robert D. Truog  Nancy Berlinger  Rachel L. Zacharias  Mildred Z. Solomon

Abstract: This special report is published in commemoration of the fiftieth anniversary of the “Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death,” a landmark document that proposed a new way to define death, with implications that advanced the field of organ transplantation. This remarkable success notwithstanding, the concept has raised lasting questions about what it means to be dead. Is death defined in terms of the biological failure of the organism to maintain integrated functioning? Can death be declared on the basis of severe neurological injury even when biological functions remain intact? Is death essentially a social construct that can be defined in different ways, based on human judgment? These issues, and more, are discussed and debated in this report by leading experts in the field, many of whom have been engaged with this topic for decades.

And here's an article about the report in Forbes (it seems to be in their section on "retirement":-)
What Does "Dead" Mean? The Debate Continues Some 50 Years After Harvard Defined Death.  Robin Seaton Jefferson

“Capron, one of the architects of the UDDA, summarized the situation well in 2001 when he described efforts to determine when death has occurred as both ‘well settled, yet still unresolved.’

The article suggests that we won't have to worry about precise definitions of death once we don't need deceased donors for transplantation any more, but I'm not so sure.  Ventilators help keep people alive while their bodies are struggling, and some will recover.  But if not, there is still often a decision to be made about when to disconnect the ventilator, and make it available for someone who still has a chance of recovery.

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