scholarly journals The intractable problems with brain death and possible solutions

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ari R. Joffe ◽  
Gurpreet Khaira ◽  
Allan R. de Caen
Keyword(s):  
Brain Death ◽  
The State ◽  
Human Organism ◽  
Irreversible Loss ◽  
Acceptable Solution ◽  
Definition Of Death ◽  
Brain Functions ◽  
Metaphysical Problem ◽  
Dead Donor Rule ◽  
Intractable Problems

AbstractBrain death has been accepted worldwide medically and legally as the biological state of death of the organism. Nevertheless, the literature has described persistent problems with this acceptance ever since brain death was described. Many of these problems are not widely known or properly understood by much of the medical community. Here we aim to clarify these issues, based on the two intractable problems in the brain death debates. First, the metaphysical problem: there is no reason that withstands critical scrutiny to believe that BD is the state of biological death of the human organism. Second, the epistemic problem: there is no way currently to diagnose the state of BD, the irreversible loss of all brain functions, using clinical tests and ancillary tests, given potential confounders to testing. We discuss these problems and their main objections and conclude that these problems are intractable in that there has been no acceptable solution offered other than bare assertions of an ‘operational definition’ of death. We present possible ways to move forward that accept both the metaphysical problem - that BD is not biological death of the human organism - and the epistemic problem - that as currently diagnosed, BD is a devastating neurological state where recovery of sentience is very unlikely, but not a confirmed state of irreversible loss of all [critical] brain functions. We argue that the best solution is to abandon the dead donor rule, thus allowing vital organ donation from patients currently diagnosed as BD, assuming appropriate changes are made to the consent process and to laws about killing.

scholarly journals Diagnosis of brain death

2010 ◽  
Vol 2 (1) ◽  
pp. 2 ◽  
Author(s):  
Calixto Machado
Keyword(s):  
Brain Death ◽  
Perfusion Pressure ◽  
Cellular Level ◽  
Irreversible Loss ◽  
Clinical Expression ◽  
Neuronal Tissue ◽  
Brain Functions ◽  
The Mean ◽  
The Brain ◽  
Signs Of Death

Brain death (BD) should be understood as the ultimate clinical expression of a brain catastrophe characterized by a complete and irreversible neurological stoppage, recognized by irreversible coma, absent brainstem reflexes, and apnea. The most common pattern is manifested by an elevation of intracranial pressure to a point beyond the mean arterial pressure, and hence cerebral perfusion pressure falls and, as a result, no net cerebral blood flow is present, in due course leading to permanent cytotoxic injury of the intracranial neuronal tissue. A second mechanism is an intrinsic injury affecting the nervous tissue at a cellular level which, if extensive and unremitting, can also lead to BD. We review here the methodology of diagnosing death, based on finding any of the signs of death. The irreversible loss of cardio-circulatory and respiratory functions can cause death only when ischemia and anoxia are prolonged enough to produce an irreversible destruction of the brain. The sign of such loss of brain functions, that is to say BD diagnosis, is fully reviewed.

Controversies about irreversible loss of brain functions and cerebral perfusion in brain death

2016 ◽  
Vol 23 (2) ◽  
pp. e8-e8 ◽  
Author(s):  
C. Roth ◽  
W. Deinsberger ◽  
J. Kleffmann ◽  
A. Ferbert
Keyword(s):  
Brain Death ◽  
Cerebral Perfusion ◽  
Irreversible Loss ◽  
Brain Functions

Brain death and the definition of death

2017 ◽  
Author(s):  
James L. Bernat
Keyword(s):  
Brain Death ◽  
Social Recognition ◽  
Analytic Framework ◽  
Societal Factors ◽  
Definition Of Death ◽  
Brain Functions ◽  
History Of ◽  
Commission Report ◽  
Definition Of ◽  
Future Landscape

The idea that a person is dead when brain functions have ceased irreversibly is one of the oldest and most enduring debates in neuroethics. This chapter traces the history of brain death by explaining the technological, medical, and societal factors stimulating its origin and acceptance; discusses its medical, legal, religious, and social recognition; highlights a few of its controversies; examines a recent commission report; and discusses two highly publicized cases that have reignited debates. Next, it provides the conceptual basis for brain death by analyzing the definition and criterion of death and offers an analytic framework for a biophilosophical account of death that justifies the practice of brain death, pinpoints the areas of contention, and compares competing concepts of death. It concludes with thoughts about brain death as a contemporary neuroethical issue, and predicts the future landscape of the debate over brain death and the definition of death.

Ambiguity, death determination, and the dead donor rule

2018 ◽  
Vol 13 (4) ◽  
pp. 165-171
Author(s):  
Will Lyon
Keyword(s):  
Brain Death ◽  
Organ Transplant ◽  
Organ Donors ◽  
Guiding Principle ◽  
Definition Of Death ◽  
Dead Donor Rule ◽  
Transplant Ethics ◽  
The Dead ◽  
Definition Of ◽  
Death Determination

The dead donor rule states that organ donors must be declared dead before any vital organs are removed. Recently, scholars and physicians have argued for the abandonment of the dead donor rule, based on the rule’s supposed connection with the concept of brain death, which they view as a conceptually unreliable definition of death. In this essay, I distinguish between methods of death determination and the question of whether or not the dead donor rule should be a guiding principle of organ transplant ethics. In principle, the dead donor rule does not rely on any one definition of death, but only prohibits the taking of vital organs before a patient is declared dead. In light of this distinction, I argue that even if the dead donor rule is tied to brain death in practice, conceptual disagreement about brain death does not provide grounds for rejection of this rule. I then present evidence in support of the consistency and reliability of the diagnosis of brain death. I show that, when performed carefully and under specific clinical circumstances, the diagnosis of brain death is considered by most neurologists to be reliable. Finally, I argue that, without the dead donor rule, organ transplantation programs would become susceptible to violations of the ethical principle of respect for persons.

scholarly journals Brain death as irreversible loss of a human’s moral status

2018 ◽  
Vol 8 (3-4) ◽  
pp. 167-178
Author(s):  
Piotr Grzegorz Nowak
Keyword(s):  
Brain Death ◽  
Organ Donation ◽  
Moral Status ◽  
Ordinary Language ◽  
Irreversible Loss ◽  
Life And Death ◽  
Dead Donor Rule ◽  
Biological Meaning ◽  
Brain Dead ◽  
The Brain

Abstract Singer claims that there are two ways of challenging the fact that brain-dead patients, from whom organs are usually retrieved, are in fact biologically alive. By means of the first, the so called dead donor rule may be abandoned, opening the way to lethal organ donation. In the second, it might be posited that terms such as “life” and “death” do not have any primary biological meaning and are applicable to persons instead of organisms. This second possibility permits one to acknowledge that brain-dead patients are deceased because they are irreversibly unconscious. In the commentary which follows, I will argue that Singer’s second option is preferable since it (a) provides a higher amount of organs available for transplant, and (b) is better suited to the meaning of “death” which occurs in ordinary language. I will also defend such a concept of death against the objections raised by Michael Nair-Collins in the article Can the brain-dead be harmed or wronged? On the moral status of brain death and its implications for organ transplantation.

scholarly journals Wavelet introscopy of human organism bionets

2021 ◽  
pp. 63-72
Author(s):  
Gennady M. Aldonin ◽  
◽  
Vasily V. Cherepanov ◽  
Keyword(s):  
Functional State ◽  
Human Body ◽  
Dynamic Models ◽  
Golden Ratio ◽  
The State ◽  
The Body ◽  
Human Organism ◽  
Fractal Structures ◽  
Self Similar ◽  
The Creation

In domestic and foreign practice, a great deal of experience has been accumulated in the creation of means for monitoring the functional state of the human body. The existing complexes mainly analyze the electrocardiogram, blood pressure and a number of other physiological parameters. Diagnostics is often based on formal statistical data which are not always correct due to the nonstationarity of bioprocesses and without taking into account their physical nature. An urgent task of monitoring the state of the cardiovascular system is the creation of effective algorithms for computer technologies to process biosignals based on nonlinear dynamic models of body systems since biosystems and bioprocesses have a nonlinear nature and fractal structure. The nervous and muscular systems of the heart, the vascular and bronchial systems of the human body are examples of such structures. The connection of body systems with their organization in the form of self-similar fractal structures with scaling close to the “golden ratio” makes it possible to diagnose them topically. It is possible to obtain detailed information about the state of the human body’s bio-networks for topical diagnostics on the basis of the wavelet analysis of biosignals (the so-called wavelet-introscopy). With the help of wavelet transform, it is possible to reveal the structure of biosystems and bioprocesses, as a picture of the lines of local extrema of wavelet diagrams of biosignals. Mathematical models and software for wavelet introscopy make it possible to extract additional information from biosignals about the state of biosystems. Early detection of latent forms of diseases using wavelet introscopy can shorten the cure time and reduce the consequences of disorders of the functional state of the body (FSO), and reduce the risk of disability. Taking into account the factors of organizing the body’s biosystems in the form of self-similar fractal structures with a scaling close to the “golden ratio” makes it possible to create a technique for topical diagnostics of the most important biosystems of the human body.

scholarly journals NEGARA DAN KEPEMIMPINAN DALAM PEMIKIRAN ALFARABI

2017 ◽  
Vol 14 (2) ◽  
pp. 283
Author(s):  
Imam Sukardi
Keyword(s):  
Political Thought ◽  
The State ◽  
Human Organism ◽  
Ideal State ◽  
Political Concept ◽  
The Social ◽  
Original Works ◽  
Universal Values ◽  
The Government ◽  
The Ideal

The political concept of Alfarabi is derivated from the concept of Platonic, Aristotelian, and Islam. The ideal state is the state which is elaborated the universal values of humanism, not just limited to certain ethnic and nation which is emphasizing its obedience just to God, not the something else. In this paper, the writer tried to interpret the original works of Alfarabi which is directly related to his political thought and the other thinkers who are studying his political thought. In his political thought, Alfarabi emphasized that the main purpose of the state is to make the social-welfare for its citizens. Based on the organic theory, Alfarabi stated that the government of the state is just look-like the human organism system. In which, each of the existing element functioned to strengthen each other to achieve one goal. The ideal state for Alfarabi is the state which is having the goals for its citizen welfare, and who become the prime leader is a philosopher, who is having the prophetic character, having the wider knowledge, and able to communicate with al 'aql al fa’al trough al ‘aql mustafad. 

scholarly journals Pope John Paul II and the Neurological Standard for the Determination of Death: A Critical Analysis of his Address to the Transplantation Society

2017 ◽  
Vol 84 (2) ◽  
pp. 155-186 ◽  
Author(s):  
Doyen Nguyen
Keyword(s):  
Brain Death ◽  
Catholic Church ◽  
The Body ◽  
Human Organism ◽  
Determination Of Death ◽  
Pope John Paul Ii ◽  
John Paul Ii ◽  
The Brain ◽  
The Catholic Church

The introduction of the “brain death” criterion constitutes a significant paradigm shift in the determination of death. The perception of the public at large is that the Catholic Church has formally endorsed this neurological standard. However, a critical reading of the only magisterial document on this subject, Pope John Paul II's 2000 address, shows that the pope's acceptance of the neurological criterion is conditional in that it entails a twofold requirement. It requires that certain medical presuppositions of the neurological standard are fulfilled, and that its philosophical premise coheres with the Church's teaching on the body-soul union. This article demonstrates that the medical presuppositions are not fulfilled, and that the doctrine of the brain as the central somatic integrator of the body does not cohere either with the current holistic understanding of the human organism or with the Church's Thomistic doctrine of the soul as the form of the body. Summary The concept of “brain death” (the neurological basis for legally declaring a person dead) has caused much controversy since its inception. In this regard, it has been generally perceived that the Catholic Church has officially affirmed the “brain death” criterion. The address of Pope John Paul II in 2000 shows, however, that he only gave it a conditional acceptance, one which requires that several medical and philosophical presuppositions of the “brain death” standard be fulfilled. This article demonstrates, taking into consideration both the empirical evidence and the Church's Thomistic anthropology, that the presuppositions have not been fulfilled.

scholarly journals Practice Current: When do you order ancillary tests to determine brain death?

2018 ◽  
Vol 8 (3) ◽  
pp. 266-274 ◽  
Author(s):  
Nathaniel M. Robbins ◽  
James L. Bernat
Keyword(s):  
Brain Death ◽  
Clinical Examination ◽  
Online Survey ◽  
Mechanism Of Injury ◽  
Preliminary Results ◽  
Definition Of Death ◽  
Primary Mechanism ◽  
Brainstem Injury ◽  
Definition Of ◽  
Case Based

Brain death has been accepted as a legal definition of death in most countries, but practices for determining brain death vary widely. One source of variation is in the use of ancillary tests to assist in the diagnosis of brain death. Through case-based discussions with 3 experts from 3 continents, this article discusses selected aspects of brain death, with a focus on the use of ancillary tests. In particular, we explore the following questions: Are ancillary tests necessary, or is the clinical examination sufficient? What ancillary tests are preferred, and under which circumstances? Are ancillary tests required when the primary mechanism of injury is brainstem injury? Should the family's wishes play a role in the need for ancillary tests? The same case-based questions were posed to the rest of our readership in an online survey, the preliminary results of which are also presented.

Brain death and the vegetative state

2010 ◽  
pp. 4847-4850
Author(s):  
P.J. Hutchinson ◽  
J.D. Pickard
Keyword(s):  
Brain Death ◽  
Brain Stem ◽  
Vegetative State ◽  
Clinical State ◽  
Irreversible Loss ◽  
Brain Stem Death ◽  
Brainstem Function ◽  
Irreversible Cessation

Death can be defined as the irreversible loss of the capacity for consciousness and brain stem function, combined with irreversible loss of the capacity to breathe. The irreversible cessation of brainstem function, whether caused by a primary intracranial catastrophe (e.g. trauma, haemorrhage) or the result of extracranial cranial events (e.g hypoxia), will result in the same clinical state, hence brain stem death is the same as death of the patient....

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