Redefining brain death will help people understand, when the person really died, even if his heart keeps beating.
As part of the World Brain Death Project, a group of doctors from different countries wrote recommendations that will help determine whether the human brain has completely and irreversibly ceased to function. This is necessary in order to determine when the patient can be disconnected from the life support system.
We die with the brain. But it is not always easy to draw the line between life and death. In a new work, doctors tried to clarify this issue.
Brain death has been a stable concept in medicine for decades. But people define it differently, says neurocritical therapist Jin Sung of the University of Southern California at Los Angeles: “We hope that reaching some sort of worldwide consensus and agreement will minimize the misunderstanding of what brain death is.”
The group of doctors included experts in the field of intensive care, neurology and neurosurgery. In the process of work, in addition to the main recommendations, 17 points appeared that relate to legal and religious aspects. “Basically, we wrote a book,” Sung says.
The minimum requirement for determining brain death is “a thorough clinical examination,” Sung emphasizes. Before the examination, doctors must make sure that the person has a neurological injury or condition that could cause brain death. Then, clinicians must find other explanations and conditions that can mimic brain death but are reversible. Cooling the body and treating heart attacks can temporarily impair brain function, the report points out. The same can be said for certain drugs, alcohol and other toxins.
Assessment of brain death should include a series of tests for physical responses: eye movement, pain and gagging. Doctors should also note if the person is trying to breathe on their own. In the absence of the listed signs of vital activity, a person can be considered dead. Additional tests, such as checking blood flow or electrical activity in the brain, are helpful, but their interpretation is not always easy, warn the recommendations.
Determination of brain death in adults should include one neurologic examination, and in children, two. According to pediatric neurologist Paul Graham Fisher of Stanford University, it’s high time for doctors to clarify the issue of brain death. But this is only the first step, he says: “it is not the doctors who need to get involved, too.”
According to Fisher, complex cultural, religious and even legal subtleties and peculiarities prevent the emergence of a generally accepted definition of brain death – in different countries, and even in different hospitals, today there are different rules for determining brain death.