Matters of life and death—and the physician’s role—invite criticisms and alternate interpretations. Commentaries against the clinical diagnosis of brain death or the concept of brain death have shifted their focus. These range from criticisms of the Harvard Committee (alleging conflict of interest, as shown by the presence of transplant physicians), to clinical examination (alleging injury with the apnea test), to critiques of the total brain necrosis criteria (alleging intact pituitary and hypothalamic function), to critiques on the difficulty of support (alleging long-term support in pregnant “brain-dead” women and children) and, most recently, to critiques on irreversibility (alleging possible recoveries). Philosophical arguments may reach the bedside, which may become consequential. In this chapter, a fair assessment of these criticisms, particularly those regarding determination of brain death, is provided, followed by a rebuttal. Practitioners should be aware of the existing body of literature analyzed herein.
Brain-Dead Donor-Derived Plasma Extracellular Vesicles May Induce Systemic Inflammation and Microvascular Dysfunction
