Brain Death

2019 ◽  
pp. 437-448
Author(s):  
Jerome B. Posner ◽  
Clifford B. Saper ◽  
Nicholas D. Schiff ◽  
Jan Claassen
Keyword(s):  
Brain Death ◽  
Laboratory Tests ◽  
Clinical Signs ◽  
Clinical History ◽  
Confounding Variables ◽  
Vegetative Survival ◽  
Brain Dead Patient ◽  
Brain Dead ◽  
The Brain ◽  
Prolonged Coma

This chapter considers the issue of brain death. The cornerstone of the diagnosis of brain death is a careful and sure clinical neurologic examination. In addition, a thorough evaluation of clinical history, neuroradiologic studies, and laboratory tests needs to be carried out to rule out potential confounding variables. The diagnosis of brain death rests on two major and indispensable tenets. The first is that the cause of brain nonfunction must be inherently irreversible. The second is that the vital structures of the brain necessary to maintain consciousness and independent vegetative survival are damaged beyond all possible recovery. It looks at how to determine that brain death has occurred. It goes on to outline the clinical signs for brain death. The chapter also looks at the differences between brain death and prolonged coma. Finally, it explains the management of the brain dead patient.

scholarly journals Immanuel Kant’s categorical imperative and the brain-dead patient

2015 ◽  
Vol 41 (6) ◽  
pp. 1153-1153
Author(s):  
Erwin J. O. Kompanje ◽  
Yorick de Groot
Keyword(s):  
Categorical Imperative ◽  
Brain Dead Patient ◽  
Brain Dead ◽  
The Brain

Confounding Brain Stem Function During Pediatric Brain Death Determination: Two Case Reports

2017 ◽  
Vol 32 (7) ◽  
pp. 676-679 ◽  
Author(s):  
Gregory Hansen ◽  
Ari R. Joffe
Keyword(s):  
Brain Death ◽  
Brain Stem ◽  
Case Reports ◽  
Clinical Signs ◽  
Brain Death Determination ◽  
Brain Dead ◽  
Death Determination ◽  
Pediatric Brain

A patient who has been declared brain dead is considered to be both legally and clinically dead. However, we report 2 pediatric cases in which the patients demonstrated clinical signs of brain stem function that are not recognized or tested in current Canadian or US guidelines.

scholarly journals Clinical motivation for31P MRS studies on the myocardial energy metabolism of brain dead cats

2003 ◽  
Vol 17 (2-3) ◽  
pp. 503-510
Author(s):  
G. J. Brandon Bravo Bruinsma ◽  
C. J. A. Van Echteld
Keyword(s):  
Energy Metabolism ◽  
Brain Death ◽  
Hemodynamic Instability ◽  
High Energy ◽  
Exclusion Criterion ◽  
High Energy Phosphates ◽  
Myocardial Energy Metabolism ◽  
Brain Dead ◽  
The Brain ◽  
Death Group

Hemodynamic instability of the brain dead potential heart donor is an exclusion criterion for heart donation for transplantation. Based on the results of myocardial biopsies it has been reported that brain death-related catecholamine induced damage of the heart causes depletion of high-energy phosphates which could explain contractile dysfunction. Our group has shown in a series of31P MRS experiments in cats that neither the onset of brain death, nor the hemodynamic deterioration which follows, nor its treatment with high dosages of dopamine affect the heart energetically as expressed by PCr/ATP ratios. However, after cardioplegic arrest and explantation, an initial and prolonged lower ATP content and an anomalous higher PCr/ATP ratio in the brain death group was found when compared with controls during long-term unperfused cold storage of the hearts. During subsequent reperfusion of the hearts, ATP and PCr levels in the brain death group were lower than in controls but equal partial recovery of PCr/ATP ratios was observed in both groups. It was concluded that PCr/ATP ratios need to be interpreted with great caution. Secondly, brain death-related hemodynamic instability is not related to significant changes of myocardial energy metabolism. Thirdly, brain death does affect the myocardial energy metabolism but the impact became apparent only during hypothermic storage and subsequent reperfusion of the donor heart.

Challenges to the Determination of Death by Neurological Criteria

2019 ◽  
Vol 19 (4) ◽  
pp. 583-599
Author(s):  
Tadeusz Pacholczyk ◽  
Stephen Hannan ◽  
Keyword(s):  
Brain Death ◽  
Determination Of Death ◽  
Ethical Concerns ◽  
Diagnostic Practices ◽  
Testing Potential ◽  
Brain Dead ◽  
Testing Protocols ◽  
The Brain ◽  
Apnea Testing

Ethical concerns regarding the conceptual framework for the determination of death by neurological criteria, including several clinical and diagnostic practices, are addressed. The significance of a diagnosis of brain death, diagnostic criteria, and certain technical aspects of the brain-death exam are presented. Standard and ancillary tests that typically help achieve prudential certitude that an individual has died are indicated. Ethical concerns surrounding interinstitutional variability of testing protocols are evaluated and considered, as are potential apnea-testing confounders such as hypotension, hypoxemia, hypercarbia, and penumbra effects during ancillary testing. Potential adjustments to apnea-testing protocols involving capnography, thoracic impedance monitors, or spirometers to assess respiratory efforts are discussed. Situations in which individuals determined to be brain dead “wake up,” or fail to manifest the imminent cessation of somatic functioning typically seen when supported only by a ventilator, are also briefly reviewed.

Laboratory criteria of brain death

1973 ◽  
Vol 39 (4) ◽  
pp. 429-433 ◽  
Author(s):  
Georges Ouaknine ◽  
Isaac Z. Kosary ◽  
Jackson Braham ◽  
Pinhas Czerniak ◽  
Hillel Nathan
Keyword(s):  
Brain Death ◽  
Laboratory Tests ◽  
Brain Temperature ◽  
Clinical Signs ◽  
Content Type ◽  
Bedside Tests ◽  
New Procedures ◽  
Fine Print

✓ Thirty patients with the clinical signs of brain death were subjected to a series of laboratory tests reputed to be capable of confirming this state. Three new procedures, electronystagmography, RISA intrathecal studies, and brain temperature tests, are described. The authors conclude that certain bedside tests, namely, electroencephalography, echoencephalography, electronystagmography, and electrocardiographic response to atropine, have been shown to be entirely adequate for a confident diagnosis.

HYPOTHALAMIC-PITUITARY FUNCTION IN THE "BRAIN-DEAD" PATIENT

The Lancet ◽  
1980 ◽  
Vol 316 (8206) ◽  
pp. 1259 ◽  
Author(s):  
G.M. Hall ◽  
K. Mashiter ◽  
Jean Lumley ◽  
J.G. Robson
Keyword(s):  
Pituitary Function ◽  
Brain Dead Patient ◽  
Brain Dead ◽  
The Brain

Medicine, Technology, and Religion Reconsidered: The Case of Brain Death Definition in Israel

2018 ◽  
Vol 44 (2) ◽  
pp. 186-208 ◽  
Author(s):  
Sky Edith Gross ◽  
Shai Lavi ◽  
Hagai Boas
Keyword(s):  
Brain Death ◽  
Scientific Community ◽  
Ethical Considerations ◽  
Medical Expertise ◽  
Religious Doctrine ◽  
Scientific Rhetoric ◽  
Truth Claims ◽  
Brain Dead ◽  
Scientific Ethos ◽  
The Brain

The introduction of respiratory machines in the 1950s may have saved the lives of many, but it also challenged the notion of death itself. This development endowed “machines” with the power to form a unique ontological creature: a live body with a “dead” brain. While technology may be blamed for complicating things in the first place, it is also called on to solve the resulting quandaries. Indeed, it is not the birth of the “brain-dead” that concerns us most, but rather its association with a web of epistemological and ethical considerations, where technology plays a central role. The brain death debate in Israel introduces highly sophisticated religious thought and authoritative medical expertise. At focus are the religious acceptance and rejection of brain death by a technologically savvy group of rabbis whose religious doctrine––along with a particular form of religious reasoning––is used to support the truth claims made from the scientific community (brain death is death) but challenge the ways in which they are made credible (instrumental rather than clinical). In our case, brain death as “true” death is made religiously viable with the very use of technological apparatus and scientific rhetoric that stand at the heart of the scientific ethos.

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