Friday, May 6, 2022

What Does It Mean When Someone Is Brain Dead

Don't Miss

What Does The Public Know About Brain Death

Portrayal of provides public education and affects perceptions of and formation of opinions on these topics.1,2 An analysis of media coverage of brain death prior to 2016 revealed that misinformation was presented in 72% of articles.3 Imprecise use of medical terms and misrepresentation of brain death as a state of life or a form of neurological impairment rather than a form of death were the most common errors.3 In this study and another one based on newspaper articles published between 2005 and 2009, the actual medical meaning of the term brain death was explained in less than 4% of articles.3,4 Brain death as a prerequisite for organ donation was mentioned in less than a third of articles.3,4 Similarly, portrayal of brain death in film and television is misleading, with a complete understanding of brain death presented in only 13% of productions.5 Furthermore, brain dead is used colloquially, often to refer to a person or action considered thoughtless.4 Examples of misinformation and imprecise use of brain death terminology are shown in the Table.

Table.

Examples of Misinformation and Misrepresentation of Brain Death in Media

Type of Misinformation
Colloquial use of brain death terminologyEmmanuel Macron warns Europe: NATO is becoming brain-deadEconomist10

An Internal Medicine Doctor Explains What Life

A person is declared brain dead, but the family insists on keeping that person on a ventilator.

They believe that as long as the heart beats , that their family member is alive and cant possibly be dead.

What else besides heartbeat can a brain dead body do while being prevented from decomposing via the ventilator ?

First off, the hair and nails will continue to grow, get longer.

At this point , all we are doing is keeping the individual cells and organs of the body alive, says Jacob Teitelbaum, MD, medical director of the Fibromyalgia and Fatigue Centers nationally, and author of The Fatigue and Fibromyalgia Solution.

So hair will grow, nails will grow, and urination will continue.

Interestingly, in the Jahi McMath case, the day-by-day reports have never mentioned anything about a catheter to collect urine, even though Jahis kidneys were allegedly functioning, leading to excrement.

And if the kidneys are working, the liver, pancreas and entire G.I. tract must also be working. Seems that the body, then, was alive, right?

Dr. Teitelbaum says, Meanwhile, the muscles will atrophy and shrink, the body will get severe contractures and bed sores, and the process that occurs after burial occurs instead, in a hospital bed, albeit more slowly.

So even though some of the bodys systems are functioning, the PERSON is dead. The person as a whole, is dead.

The body can continue to do most of the basic metabolic functioning on life support, says Dr. Teitelbaum.

Brain Dead Patients Waking Up

Although rare, there have been cases of patients who were declared brain dead waking up suddenly, sometimes after spending years in a coma. Colleen Burns was diagnosed by doctors with irreversible brain damage. However, just as she was about to be taken back for her organs to be donated, she woke up on her own. Another woman, Taylor Hale, was in an accident where she fell off the hood of a car. Her doctors told the family there was no way she could come back from that kind of brain damage. However, after some prayer, she woke up. Despite having no memories from before the accident, she lives a normal life.

The Diagnosis Of Brain Death

Acute catastrophic brain injury involving both hemispheres of the brain rarely leads to brain death. That would require loss of brainstem function and typically is a consequence of a massive hemispheric lesion compressing and damaging the mesencephalon, pons, and medulla oblongata. As a result of its natural resilience, the brainstem rarely stops functioning completely. This fundamental neurologic principle of the brainstem to be the last structure to lose function has been known for centuries and even to Jean-Martin Charcot, one of the founders of neurology, who said it was the last structure to die.

Clear standards for determining pediatric brain death were established by a multidisciplinary task force more than 25 years ago. These consensus standards have been widely adopted and have been revisited by the Society of Critical Care Medicine, the American Academy of Pediatrics, and the Child Neurology Society. The most current pediatric guideline recommends 2 examinations 12 hours apart by 2 different attending physicians in children 1 year or older. This is different from adult brain death guidelines, which require only one full examination . Whether a waiting interval in children is needed or even rational has been debated.

Whole Brain Or Higher Brain

Diagnosis and Causes of Brain Death

What if there is irreversible cerebral damage and only the brain stem continues to show activity?  Are you alive? A philosophical argument put forward by Robert Veatch in 1975 proposes that death is the irreversible loss of that which is essentially significant to the nature of man.  The extension of this argument is that it is the higher functions of the brain such as memory and consciousness that are significant to the nature of man. Therefore, the irreversible loss of these functions should be treated as death.  Others argue that since these functions are mediated by the cerebral cortex, that irreversible cessation of cortical activity should be a sufficient measure of death.  While it is not the accepted formal definition of death, as we will see, the nature of measurement may ultimately deem it so.

Life After Brain Death: Is The Body Still ‘alive’

A 13-year-old girl in California continues to be on a ventilator after being declared brain-dead by doctors. Although a brain-dead person is not legally alive, how much of the body will keep on working with the help of technology, and for how long?

Jahi McMath of Oakland, Calif., was declared last month after experiencing an extremely rare complication from tonsil surgery. Jahi’s family members have fought to keep their daughter on a ventilator, but a judge has ordered that the machine be turned off next week.

A person is considered brain-dead when he or she no longer has any neurological activity in the brain or brain stem meaning no electrical impulses are being sent between brain cells. Doctors perform a number of tests to determine whether someone is brain-dead, one of which checks whether the individual can initiate his or her own breath, a very primitive reflex carried out by the brain stem, said Dr. Diana Greene-Chandos, an assistant professor of neurological surgery and neurology at Ohio State University Wexner Medical Center. “It’s the last thing to go,” Greene-Chandos said.

In the United States and many other countries, a person is legally dead if he or she permanently loses all brain activity or all breathing and circulatory functions. In Jahi’s case, three doctors have concluded that she is brain-dead.

With just a ventilator, some biological processes including kidney and gastric functions can continue for about a week, Greene-Chandos said. 

Does Brain Dead Mean Dead

No matter what side of the pro-life debate you are on, it is apparent that important issues are at stake in Jahi McMath’s case. Her family, in utilizing a religious exemption for her declared death, may encourage other families in similar situations to do the same. While everyone has a right to life, the question arises how far does this right extend? Life support machines are quite expensive to operate. If brain dead people continue to receive care, who should pay for it? For example, if the McMath family wins their case, they will likely request federal medical and disability benefits in Jahi’s name. Not all taxpayers would be content seeing their tax dollars go to care for a patient that doctors have decidedly declared as dead. As a society, where should we draw the line?

Tests To Confirm Brain Death

Although rare, a few things can make it appear as though someone is brain dead.

These include drug overdoses and severe , where body temperature drops below 32C.

A number of tests are carried out to check for brain death, such as shining a torch into both eyes to see if they react to the light.

Find out more about confirming brain death

Organ Donation Following Brain Death

What does brain death mean?What causes brain death?How does a physician determine brain death?I have always understood that when a person dies, the heart stops beating. If my loved one is brain dead, why does their heart continue to beat?Is it possible that our loved one is just in a coma?Does the patient feel any pain or suffer after brain death is declared?Is there anything else that can be done?Are there any proven cases where patients were declared brain dead and later restored to normal life?Are all families approached about the option of organ donation?Why must the ventilator be kept on after a person is declared brain dead?What happens next?Will our religion support our decision about organ and tissue donation?

LifeShare University is brought to you by LifeShare Transplant Donor Services of Oklahoma4705 NW Expressway Oklahoma City, OK 73132 840-5551

The Patient Is Eligible For Organ Donation

Unlike a coma or vegetative state patient, a doctor may clear a brain dead patient for organ donation , and these patients are in fact are among prime candidates to save others through tissue or organ transplants, OrganTransplants.org.

The source explains that in the U.S., most organ donations are from brain dead patients but less than 1-percent of all annual deaths in the country are a result of brain death. Vital organs such as the heart can still be used, as opposed to someone who has died from cardiac arrest where vital organs quickly become unusable for transplantation. However, tissues and bone can still be used up to 24-hours following death in cardiac arrest cases, it adds.

Responsibilities Of Physicians Determining Brain Death

The diagnosis of brain death is primarily clinical. No other tests are required if the full clinical examination, including each of two assessments of brain stem reflexes and a single apnoea test, is conclusively performed. In the absence of either complete clinical findings consistent with brain death, or confirmatory tests demonstrating brain death, brain death cannot be diagnosed and certified. These guidelines apply to patients one year of age or older.

Withdrawing Life Support Causes Death

Ever since the New Jersey Supreme Court’s decision in the Karen Ann Quinlan case in 1976, a generally accepted ethical norm is that withdrawal of life support does not cause the patients death, rather, withdrawing life support allows the patient to die it is the disease that causes the patients death, not the physician. Yet, this view cannot be correct, because the agent that is the proximate cause of the patient’s death is the physician. Miller and Truog illustrate this by hypothesizing two patients who are in identical clinical situations; both are ventilator-dependent. One patient is disconnected from the ventilator by someone who wants to kill the patient, and the other is disconnected by a physician responding to the patient’s request to remove unwanted end-of-life technology. It is patently inconsistent to claim that in the first case, death was caused by the person who disconnected the ventilator , yet in the second case, the death was not caused by the physician who disconnected, but by the disease. There is obviously an enormous moral difference between the two acts, but the agent causing death in both cases is the person who withdrew support.

Brain Dead Means Dead

Brain Death

If someone is brain dead, the person is dead, period.

This fact can be hard to accept, particularly when a patient might look very much alive to family members. Brain dead people often still have a heartbeat, and their chests may rise and fall with the help of a ventilator, sometimes giving hope to grieving families that the person may suddenly wake up.

This false hope, some experts believe, prevents people from donating organs. People fear that their organs, or those of their loved ones, might be taken before they’re actually dead. Some suspect a doctor might “pull the plug” prematurely to harvest their organs.

“It comes up all the time,” said Von Roebuck, spokesman for the California Transplant Donor Network. “It’s a dire myth. One must remember that if you’re in a critical situation, every effort is going to be made to save your life whether you’re a donor or not.”

This myth and , such as the misconception that many are against donation, contribute to a deficit of about 75,000 organs in the United States. About 6,000 of the patients who wait for these organs die every year.

“The utility of using dead bodies is growing, as is the tragedy of not using them,” said Dr. Stuart Youngner, director of the Center for Biomedical Ethics at Case Western University. Youngner spoke at a seminar last month for journalists on covering biotechnology held by the Foundation for American Communications.

How Is It Decided That An Individual Is Brain Dead

A doctor will do tests to make a diagnosis of brain death. These tests are based on sound and legally accepted medical guidelines. Tests include a clinical examination to show that an individual has no brain reflexes and cannot breathe on his or her own. In some situations, other tests may be needed. You can ask your doctor to explain or show you how brain death was determined for your loved one.

Possibly, an individual may show spinal activity or reflexes such as twitching or muscle contractions. Spinal reflexes are caused by electrical impulses that remain in the spinal column. These reflexes may happen even though the brain is dead.

Brain Death Is Legal Death

If someone’s brain dead, the damage is irreversible and, according to UK law, the person has died.

It can be confusing to be told someone has brain death, because their life support machine will keep their heart beating and their chest will still rise and fall with every breath from the ventilator.

But they will not ever regain consciousness or start breathing on their own again. They have already died.

Patients Dont Respond To Pain

The normal ways a person may recoil or verbalize pain are absent when they have experienced brain death. However, ScienceDaily posted an interesting that states a patient may still have spontaneous movements following a brain death diagnosis.

Pain signals normally travel to the brain for a reaction, but these sudden movements in brain dead patients are spinal reflexes that do not involve any brain activity, according to an expert cited by the source. A study in Argentina shows that of 38-clinically brain dead patients, 15-of them had motor movements in the first 24-hours, but none after 72-hours. Electroencephalogram tests confirmed there was no brain activity in the patients that moved, it adds.

What Does Brain Death Mean

Brain death is a legal definition of death. It is the complete stopping of all brain function and cannot be reversed. It means that, because of extreme and serious trauma or injury to the brain, the body’s blood supply to the brain is blocked, and the brain dies. Brain death is death. It is permanent.

Criticism Of The Concept Of Brain Death

Criticism of the concept of brain death immediately arose within both the medical and the philosophical-ethical community24,25 when the original criteria were introduced, because it is difficult to come to terms with a concept of death that abandons our long-cherished idea of a sensual perception of death and an exact point in time when death occurs. Even in the Harvard report, the difference between the previously sole criterion of cardiac death with visible cessation of heartbeat and respirationand hence a visibly defined time point of deathand the lack of such signs with brain death, was recognized.17 Debates began about whether it was appropriate to accept brain death as death.25

Philosophical-ethical objections. Philosophical-ethical objections to the concept of brain death were first prominently put forward by the philosopher Hans Jonas. He was concerned about the possibility that brain death might be used as a means of pragmatically redefining death, thereby freeing patients, their relatives, and medical resources from the burden of an indefinitely prolonged coma and increasing the supply of organs for donation,24 a criticism that has persisted.26 A similar point of ethical criticism is that stopping life support might mean ending a human life for utilitarian reasons by regarding brain death as a convenient redefinition of death for the purposes of transplantation medicine.27

About Brain Stem Death

Brain stem death is when a person no longer has any brain stem functions, and has permanently lost the potential for consciousness and the capacity to breathe.

When this happens, a ventilator keeps the person’s heart beating and oxygen circulating through their bloodstream.

A person is confirmed as being dead when their brain stem function is permanently lost.

Brain Death And Organ Donation

In some cases, a person who is brain dead may be a candidate for organ donation. If the person was a registered organ donor, or if their family knew of their wish to be an organ donor, their death is declared, but the ventilator is left on. Drugs that help preserve the internal organs are still given. The dead person then undergoes an operation to remove viable organs such as kidneys. After the operation is complete, the ventilator is switched off. Funeral arrangements can then be made by the family.

Ruling Out Other Conditions

How Do We Know Somebody Is Truly Brain Dead?  Awakening ...

Before testing for brain stem death can begin, doctors must carry out a series of checks to ensure that the symptoms aren’t being caused by other factors, such as:

  • an overdose of illegal drugs, tranquillisers, poisons or other chemical agents
  • an abnormally low body temperature
  • severe under-activity of the thyroid gland

Once these factors have been ruled out, tests are carried out to confirm brain death. The diagnosis of brain death has to be made by two senior doctors. Neither of them can be involved with the hospital’s transplant team.

The doctors will explain the tests to you and they’ll keep you informed about your loved one’s condition at all times.

The Heart Will Stop Beating Without A Ventilator

An article from LiveScience that some cases of brain death can be especially tough on families, because some of the bodily functions such as a heartbeat continue after brainwave activity has been shown to be absent.

In fact, the heart has an intrinsic electrical system that allows it to continue beating without assistance from the brain, and it can even continue beating outside of the body, it adds. However, without the assistance of a ventilator providing a continuous flow of oxygen and blood, this beating would stop very quickly, usually in less than an hour, it notes.

Diagnosing Brain Stem Death

There are a number of criteria for diagnosing brain stem death.

For a diagnosis of brain stem death to be made:

  • a person must be unconscious and fail to respond to outside stimulation
  • a person’s heartbeat and breathing can only be maintained using a ventilator
  • there must be clear evidence that serious brain damage has occurred and it can’t be cured

New Technology Changes Definition

Long before early humans had any idea of the importance of the brain, people judged when someone was dead using simple observation. The person would stop moving, grow stiff, cold, and bluish, and eventually, start to rot.

Then, as early medicine began to emerge, ancient physicians understanding of death grew more precise. When a person stopped breathing and their heart stopped beating, they were dead. And generally, one would swiftly follow the other. This definition remained for thousands of years.

Although scientists had figured out that the brain was vital by the turn of the 20th century, the knowledge wasnt applicable. Loss of breath or heartbeat invariably resulted in death of the brain as well. But after the close of World War II, medicine experienced a revolution.

Several new innovations came on the heels of one another.

CPR was invented as was the mechanical ventilator, severing the connection between loss of breathing and death.

The intensive care unit was established, giving life-saving opportunities to people who would have previously died of heart failure.

And perhaps most crucially, technologies and medicines improved enough to make organ transplantation feasible.

Together, these developments called for a new definition of death. They also raised a whole series of new questions.

If someone shoots another person and that person suffers brain death, but their body is kept alive in the hospital, is the shooter a murderer?

Declaring Brain Death: The Neurologic Criteria

  • Amal Puswella

Background    This Fast Fact reviews the details of declaring death based on neurological criteria.  In 1980, the Uniform Determination of Death Act was created which stated that An individual who has sustained either 1) irreversible cessation of circulatory and respiratory function, or 2) irreversible cessation of all functions of the entire brain, including the brainstem, is dead.  A determination of death must be made with accepted medical standards.  The UDDA did not define accepted medical standards, and so the American Academy of Neurology published guidelines in 1995, and updated them in 2010.   Despite these national guidelines, there is still considerable variability in local institutional guidelines.

Determining death by neurologic criteria involves two steps:

Adjunctive or confirmatory tests are needed in complex clinical situations such as uremia or hepatic encephalopathy, when apnea testing cannot be performed, when the primary brain insult is infratentorial, or if required by the local institutional brain death policy.

References

  • Wijdicks E, Varelas P, Gronseth G, et al.  Evidence-Based guideline update:  Determining brain death in adults.  Report of the quality standards subcommittee of the American Academy of Neurology.  Neurology 2010; 74;1911-1918. 
  • Greer D, Varelas P, Haque S, et al.  Variability of brain death determination guidelines in leading US neurologic institutions.  Neurology 2008; 70:284-289.
  • How Brain Death Occurs

    Brain death can occur when the blood and/or oxygen supply to the brain is stopped. This can be caused by:

    • cardiac arrest when the heart stops beating and the brain is starved of oxygen
    • heart attack a serious medical emergency that occurs when the blood supply to the heart is suddenly blocked
    • a serious medical emergency that occurs when the blood supply to the brain is blocked or interrupted
    • blood clot a blockage in a blood vessel that disturbs or blocks the flow of blood around your body

    Brain death can also occur as a result of:

    Can You Recover From Brain Death

    No, a patient who is brain dead will not be able to recover. The body may continue to breathe with mechanical support but eventually, both the breathing and heart will stop even with continued support.

    Being brain dead is not the same as being in a coma or a prolonged vegetative state. The latter two are medical states where one may be unconscious but still show brain function.

    The media and Hollywood often use these terms interchangeably. But both medically and legally, brain death is its own distinguishable diagnosis that one cannot recover from.

    Are There Drugs That Can Stop The Brain From Working And Give A False Diagnosis

    Certain drugs can mask brain function, such as muscle relaxants and sedatives. Testing can only be done when the individual has low levels of these drugs in the body. It may be necessary to wait for these levels to go down. The doctor can then accurately measure brain activity. Sometimes, other tests are done to confirm brain death if certain drugs are present in the body.

    What Is Brain Death

    Brain death Present status YDS

    Brain Death is when an irreversible and complete loss of brain and brain stem function has taken place. This means that there is absolutely no brain activity and brain activity will not return.

    It is considered both a legal and medical definition of death.

    At this point, the patient is incapable of surviving without mechanical support.

    You can see the difference of a brain with blood flow and brain activity, and one that is without any function.

    More articles

    Popular Articles