How Is Brain Death Confirmed
Before brain death can be confirmed, the following is required.
Two senior doctors must perform separate tests at the bedside to determine whether the brain is working or not. These doctors check to see if the cranial nerves that pass through the brain stem and control all vital reflexes are working.
They also check to see if the person:
- has any response to pain
- has any response when a light is shone in the pupil of each eye
- blinks or moves when each eye is touched
- responds to ice cold water put into the ear canal
- has a cough or gag reaction when the back of the throat is touched
- can breathe when disconnected from the ventilator.
For a person to be certified brain dead, they must show no response to every one of these tests.
In some cases, not all of these tests can be done, such as when there are extensive facial injuries. In such cases, radiological imaging is done to check if there is any blood flow to the brain.
The patients time of death will be recorded as the time that brain death was confirmed.
Cessation Of Life Support
The question of the meaning of death assumes critical significance in the decision of whether to continue life support systems. Courts are beginning to recognize the Harvard Medical School Ad Hoc Committee’s criteria in making this determination. Paramount to the issue is the question of who is to make the decision. The doctor, family, or collegiate groups, such as an ethics committee, all may be involved.
Of obvious concern to every physician faced with a persistently vegetative patient who is being kept alive mechanically is the potential criminal and civil liability for terminating the life support systems. Civil liability, if it existed, would be manifested in a judgment that a physician caused the wrongful death of the patient, and the measure of damages would be the pecuniary or monetary loss to the survivors. Criminal liability, if it existed, would take the form of a judgment that the physician was guilty of homicide, that is, murder or the varying degrees of manslaughter.
A civil action for wrongful death would be premised on the proposition that a physician committed malpractice a negligent deviation from standard and accepted practice or upon the proposition that he or she intentionally caused the patient’s death by withdrawing the supportive therapy. Criminal liability would be based on the necessary finding that the doctor had the intent to kill the patient.
Attempting To Reverse The Irreversible
The clinical trial will involve a four-step approach. The spinal cords of the brain dead subjects will be injected with stem cells, which are cells that have the ability to differentiate into other cell types, including neurons.
The stem cells minimally manipulated, autologous, adult stem cells derived and expanded from patient fat and/or peripheral blood will serve as some new bricks in the regenerative process, Pastor explained to Medical News Today.
Subjects will also be injected with a peptide called BQ-A derived from ooplasms, the cytoplasm of an egg, or oocyte which Pastor told us will act as the blue print and mortar in the regenerative process.
As well as aiding neuronal growth, Pastor explained that the peptides will help to reprogram and recondition the surrounding tissue at the location where stem cells are injected, and they will also help to target and destroy components of dead tissue.
Once these steps are complete, median nerve stimulation techniques and transcranial laser therapy will be applied to each subject for 15 days, with the aim of spurring connections between the newly formed neurons.
In short, it is our contention that there will be no single magic bullet for success and any traditional single drug approach would be fairly futile. Hence why we are employing this type of combinatorial approach, Pastor told MNT.
Secondarily, he added, we hope the trial will answer certain deeper issues about the human mind.
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What Happens To The Brain In Alzheimer’s Disease
The healthy human brain contains tens of billions of neuronsspecialized cells that process and transmit information via electrical and chemical signals. They send messages between different parts of the brain, and from the brain to the muscles and organs of the body. Alzheimers disease disrupts this communication among neurons, resulting in loss of function and cell death.
When Is There A Coronial Investigation
Every death that happens in an Intensive Care Unit in NSW is assessed to determine if a coronial investigation is required. A death must be referred to the NSW Coroner as a matter of law if:
- the person died a violent and unnatural death
- the person died a sudden death and the cause is unknown
- the person had not been under the care of a doctor within the past six months
- the person died unexpectedly after having a health-related procedure
- the person was under a custodial order or under State care at the time of death
- the doctor was unable to complete the death certificate because of unknown factors leading to the death.
Note: if the person who died wished to be an organ and tissue donor or the next of kin has agreed to donation, permission is sought from the Coroner and the forensic pathologist. If the next of kin do not wish the person who has died to become an organ and tissue donor, the Coroner and the forensic pathologist can not override their wishes.
Absolute Truth Is Elusive
Nelson says these can be powerful, sometimes life-changing events for patients, but he’s skeptical that they happen when the brain has completely shut down. He points out that electroencephalograms , which monitor brain activity, can be very difficult to interpret during resuscitation.
The chaos of an emergency room can make it difficult to pinpoint when the heart or brain might stop working. People are scrambling around equipment gets bumped, which can throw off later analysis.
âWires get jiggled, signals cross,â he says. âWe donât know if the EEG is actually flatlined, and, if it is, we donât know that the conscious experience takes place during the flat line. People are not having experiences when thereâs a true flatline EEG.â
Parniaâs research, however, does not support that conclusion.
âIn our study, we had confirmed consciousness present for at least 3-5 minutes,â he says. “Itâs a paradox. The fact that you have people who can fully recall something, who appear to have full consciousness, when the brain is shut down, suggests that consciousness may be a separate entity from the brain.”
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.
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Donation After Brain Death
Families of a brain dead patient must, by federal regulations, be provided the option of organ donation. If the family declines donation, the mechanical ventilator, medications and fluids are discontinued, after which the heart stops. If the family says yes to donation, the regional organ procurement organization is involved. The donors body is kept functioning by artificial means, such as ventilated support until the recovery of organs and tissue for life-saving transplant.
If you support donation it is important to document your decision. This removes the burden off of your loved ones to make the decision once you have passed away.
Do Brain Death And Vegetative Life
Brain Death is not synonymous with vegetative life or coma. Brain stem functions continue in vegetative life and coma states. The patients breathing and other organ functions are still under the control of the brain. However, in brain death, the brain no longer functions. Brain death is medically death and, once declared, is irreversible.
We can often come across the question, If he is dead, why is his heart still beating?. Although the brain does not function, the heart continues to beat for a limited period of time as long as breathing and life support are provided. However, since the brain death process is irreversible, the heart will stop after a while and will lose its functions in all other organs.
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Was It Really Brain Death
Twenty-one-year-old Zack Dunlap from Oklahoma appeared on NBC’s Today Show in 2008 to tell an incredible story of hearing a physician telling his parents that a PET scan confirmed that he was brain dead after a catastrophic brain injury. While he was being prepared for organ donation, however, he moved his arm purposely in response to stimuli. Dunlap recovered, went to a rehabilitation hospital, and ultimately went home 48 days later, very much alive.
Earlier this year, 13-year-old Trenton McKinley from Alabama and his parents hit the media circuit to talk about the miracle of Trenton awakening after being declared brain dead from a vehicle accident1 day before his organs were scheduled to be harvested.
The likely explanation for such “recoveries” from brain death, according to experts, is that these individuals were never brain dead in the first place. “Errors have been made where people declared brain dead were later found to have spontaneous movement that should not have been possible,” says Robert M. Sade, MD, professor of surgery and director of the Institute of Human Values in Health Care at the Medical University of South Carolina in Charleston. “In virtually all those cases, brain-death determination was not done correctly. If you don’t go through the exact protocol for brain-death determination, you’re likely to have patients diagnosed as being dead by neurologic criteria who are, in fact, not brain dead.”
- Was It Really Brain Death?
What Happens To Your Brain After You Die
First things first: if you really want to know what happens to your brain when you die, you’re going to need to abandon your squeamishness at the door. What I’m about to write here is necessary, important and has, in the case of medical donation and research, saved many thousands of lives â but it’s not very cute to read about. So leave your gag reflex behind.
Most peoples’ thoughts about the journey their brain undergoes after death center around the idea of near-death experiences, or whether the brain can keep going after the heart has stopped. But that is, for the great majority of us, only the beginning. After we die, our brains pass into the care of professionals who treat it with great respect, but who also may use it in various ways â and then, ultimately, it passes into the hands of nature or a crematory fire. It is dead tissue, but it was once the most crucial part of a human being, and for that reason it can go through quite a set of loops and roundabouts before being laid to rest.
Depending on your choices and those of your family and carers, your brain may be donated to science, sent out for autopsy, or simply injected with solutions for funeral preparation â and none of those options are particularly pretty or un-gruesome in practise.
So gear up, stay calm, and enjoy learning about one of the most interesting things that will ever happen to your body: death.
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Evolution Of The Concept Of Brain
It was against this sort of background that French neurologists, in 1958, described a condition they called coma dépassé . Their patients all had primary, irremediable, structural brain lesions were deeply comatose and were incapable of spontaneous breathing. They had not only lost their ability to react to the external world, but they also could no longer control their own internal environment. They became poikilothermic . They could not control their blood pressure or vary their heart rate in response to appropriate stimuli. They could not even retain body water and would pass great volumes of urine. The organism as a whole had clearly ceased to function. Coma dépassé was considered a frontier state between life and death. Ventilation was continued in the vast majority of such cases until the heartbeat ceased, usually a few days later.
What Happens To Your Brain Before You Die
30 August, 2019
One of humanitys greatest mysteries is what happens to the brain before you die. Scientists the world over have looked for the answer to this question, but no one has managed to come up with a clear answer.
In 2018, scientists at Charite Berlin, an academic hospital in Germany, and the University of Cincinnati in Ohio, United States tried to answer the age-old question. Their goal was to figure out what happened to the brain when its energy depleted and it stopped receiving blood.
To do that, they used electrodes to decode the brain activity of patients who had suffered a catastrophic brain injury such as a stroke. This information helped shed light on the consequences of strokes and also provided crucial insight into the neurobiology of death.
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Legal Perspectives On The Mcmath Controversy
As early as 18 days after the hospital had diagnosed Jahi McMath as dead, the Alameda County Superior Court judge held that the child was in fact dead. After confirmation by an independent physician, Judge Grillo agreed that Jahi’s medical condition met the definition set out by California’s Uniform Determination of Death Act, which states in part n individual who has sustained either irreversible cessation of circulatory and respiratory functions, or irreversible cessation of all functions of the entire brain, including the brain stem, is dead. While California’s statute does not contain a religious exception, the judge in this case provided Jahi’s parents considerable time to pursue opportunities to have her body transferred to another facility. The amount of time is significant given the moral and professional burdens on health care providers to support a body that has been declared dead.
As discussed above, Judge Grillo entered a TRO requiring that the hospital continue ventilator support until Jahi’s parents were given time to explore options for transfer. Because TROs significantly deprive the opposing party of freedom, they are reserved for situations in which the filing party is facing irreparable harm, no other legal form of remedy is available, and a substantial likelihood of success of winning a case on the merits exists. The court must balance the potential hardship to the opposing party as well as any impact on the public following their decision.
Reversing Brain Death: Far
From gene editing to human head transplantation, the limits of medical science are being pushed further than ever. And now, researchers have turned their attention to another extraordinary mission: reversing brain death.
Though it sounds similar to the makings of fiction, scientists have received approval for the first ever trial that aims to restore neuronal activity in humans who have been declared brain dead.
The proof-of-concept study which forms a part of the Reanima Project is the brainchild of two life sciences companies: Bioquark, Inc., based in the United States, and Revita Life Sciences, based in India.
Due to begin later this year, the trial will recruit 20 individuals who have suffered brain death as a result of traumatic brain injury , but whose bodies are biologically alive as a result of cardiopulmonary and trophic support a model referred to as a living cadaver.
To participate in the trial, each subject must be aged between 15 and 65 years, be unwilling for organ donation, and have written consent from a legally acceptable representative.
Researchers including Bioquark CEO Ira Pastor will test a variety of techniques that previous studies have demonstrated to possess neuroregenerative properties, and these will be combined with devices that have been shown to stimulate the central nervous system of coma patients.
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Establishing The Absence Of Respiratory Function
The final step in establishing brain death is the apnea test. Apnea is the medical term for the suspension of breathing and is used in this instance to ascertain whether the suspension is permanent.
To perform an apnea test, the doctor would take the following steps:
If there is no respiratory movement and the PaCO2 has increased to over 60meaning that there has been no exchange of oxygen and carbon dioxide in the lungsthe person will be declared brain-dead.
If on the other hand, a respiratory movement is observed, then the person cannot be considered brain-dead. Further investigations would then be performed to identify what, if anything, can be done to reverse the condition.
Vascular Contributions To Alzheimers Disease
People with dementia seldom have only Alzheimers-related changes in their brains. Any number of vascular issuesproblems that affect blood vessels, such as beta-amyloid deposits in brain arteries, atherosclerosis , and mini-strokesmay also be at play.
Vascular problems may lead to reduced blood flow and oxygen to the brain, as well as a breakdown of the blood-brain barrier, which usually protects the brain from harmful agents while allowing in glucose and other necessary factors. In a person with Alzheimers, a faulty blood-brain barrier prevents glucose from reaching the brain and prevents the clearing away of toxic beta-amyloid and tau proteins. This results in inflammation, which adds to vascular problems in the brain. Because it appears that Alzheimers is both a cause and consequence of vascular problems in the brain, researchers are seeking interventions to disrupt this complicated and destructive cycle.
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