No Consensus on Brain Death

A forthcoming article in the journal Neurology provides insight into the complexities of achieving international consensus on brain death.

The article by a team of neurologists and medical researchers from clinics and universities around the US catalogues conceptions of brain death in medical institutions around the world.

The authors found that institutional protocols were absent or poorly understood in a significant number of low-income countries. They also found that “substantial differences in perceptions and practices of brain death exist worldwide” and that “whether a harmonized, uniform standard for brain death worldwide can be achieved remains questionable.”

The study – the first to examine opinions in a broad range of countries – involved an electronic survey which was distributed globally to physicians with expertise in neurocritical care, neurology, or related disciplines who would encounter patients at risk of brain death. Physicians from 91 countries responded.

The results were quite revealing

Doctors around the world leave different periods of time following initial neurologic deterioration before they declare brain death. The most common waiting period is between 6 and 10 hours, but reported results ranged from less than 5 hours to more than 25 hours.

“There were several discrepancies regarding the conduct of apnea testing”, the authors report. Views about the import of ancillary testing (EEGs, Dopler ultrasounds etc.) differed significantly between countries.

In their discussion of the results of the study, the authors flagged a need for greater collaboration between medical institutions from different countries:

“To promulgate a unified stance on brain death, valuable for practitioners everywhere, consensus among leading experts in the field is urgently required…[our] findings underscore the importance of international partnerships between institutions to improve medical education and alleviate critical human resource needs in lower-income settings.”

In a comment on the article, Dr. James Bernat observed that there is significant disagreement on brain death even within the US.

“[There is] a surprising degree of practice variation among hospitals in the United States. In contrast to the international circumstance, in which practice disparities arise more because of legal, cultural, or religious differences, those in the United States result more from the biases and ingrained practices of individual physicians.”

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My comment

“Of course, there is no consensus, because “brain death” is NOT true death. I bet they would have no issue determining when someone is truly dead…irreversible cessation of circulatory and respiratory functions. That definition worked fine for us for thousands of years.”

That definition worked fine for us for thousands of years.

The Study

Objective: To assess the practices and perceptions of brain death determination worldwide and analyze the extent and nature of variations among countries.

Methods: An electronic survey was distributed globally to physicians with expertise in neurocritical care, neurology, or related disciplines who would encounter patients at risk of brain death.

Results: Most countries (n = 91, response rate 76%) reported a legal provision (n = 63, 70%) and an institutional protocol (n = 70, 77%) for brain death. Institutional protocols were less common in lower-income countries (2/9 of low [22%], 9/18 lower-middle [50%], 22/26 upper-middle [85%], and 37/38 high-income countries [97%], p < 0.001). Countries with an organized transplant network were more likely to have a brain death provision compared with countries without one (53/64 [83%] vs 6/25 [24%], p < 0.001).

Among institutions with a formalized brain death protocol, marked variability occurred in requisite examination findings (n = 37, 53% of respondents deviated from the American Academy of Neurology criteria), apnea testing, necessity and type of ancillary testing (most commonly required test: EEG [n = 37, 53%]), time to declaration, number and qualifications of physicians present, and criteria in children (distinct pediatric criteria: n = 38, 56%).

Conclusions: Substantial differences in perceptions and practices of brain death exist worldwide. The identification of discrepancies, improvement of gaps in medical education, and formalization of protocols in lower-income countries provide first pragmatic steps to reconciling these variations. Whether a harmonized, uniform standard for brain death worldwide can be achieved remains questionable.

Received September 29, 2014.
Accepted in final form January 7, 2015.

What if that was your family member and 53% of doctors deviated from the AANC criteria?

Opps

Let’s get rid of the legal fiction of brain death.

Last Thursday night on Grey’s Anatomy, Patrick Dempsey’s character, Derek Shepherd, was pronounced brain dead. Now Greys Anatomy for all 10 seasons has been pro-organ donation any chance they got. What was interesting is his wife, Meredith Grey had to make the decision to take him off life support. Her comments were interesting in light of the last 10 years.

Paraphrased: “Ok so now is the time you tell me you waited the number of requisite hours and now you can tell me, he is dead. So you need a bed, and you want me to sign the papers. Now that he is dead, but not really dead. Now I have to decide whether to put him in a long care facility or pull the plug and KILL him.

Did you hear that? Dead but not really dead, pull the plug and kill him?

Start at 1:11 to watch the exchange.

Grey’s Anatomy show was disgusting

Thursday night I had TV turned on to Grey’s Anatomy, it use to be a TV show I didn’t miss but the last two years I have not watched it much.

I was thoroughly disgusted by the show Thursday night. In the show a doctor with ALS wanted to die so he could donate his organs. He was alive and talking to his parents and family.

Doctor April Kepner, played by Sarah Drew on Grey’s Anatomy spoke up, “We do organ donation after brain death, you are not close to brain death.”

His mother smiled and spoke up, “He is doing DCD, donation after cardiac death.”

“Welcome to my funeral,” he said.

Dr. Cristina Yang, played by Sandra Oh on Grey’s Anatomy commented, “so what…he knows what he is doing and they are perfectly good organs we may as well use them.

The patient is wheeled down to the OR and his parents are there. They turned off his ventilator and let him die.

Then with his distraught mother crying over him they had to push her out of the room to begin the transplants.

Dr. April Kepner frantically says, “you have to go or this would have all been for nothing.”

Truth

They neglected to say in Grey’s Anatomy that in a real transplant they would have resuscitated him so that the organs could be used. The organs need oxygenated blood to survive and be used in someone else.

Parents or loved one’s can not be in the OR, they say good-bye in the patients room and then the patient is wheeled down to OR where the vivisection (from Latin vivus, meaning “alive”, and sectio, meaning “cutting”) begins.

What occurred on Grey’s Anatomy was a glorified assisted suicide. He chose to die.

In 1806 German physician Christoph Wilhelm Hufeland wrote, “ It is not up to the doctor whether life is happy or unhappy, worthwhile or not, and should he incorporate these perspectives into his trade…the doctor could well become the most dangerous person in the state.”

Hufeland’s point was that the ethics of medicine are a good indicator of the moral health of society and then when medical practice is corrupted, society is soon to follow. Culture of Death, Smith Wesley, page 37.

Think about THAT for a moment.

Most people don’t think about death, they avoid it.

Only when confronted with a health care crisis involving a loved one do they come face to face with the the monster called hospital protocols, futile care acts and the vultures behind the Organ industry in America.

Donation after cardiac death

Donation after Cardiac Death has been around since 2007. Some names it is being called are Non-Beating Heart Beat Organ Donor, (NBHOD) Donation after Cardiac Death, (DCD) and being proposed is Death by Circulatory Death. Circulatory Death is death defined as the irreversible cessation of circulatory and respiratory functions.

Is it irreversible when they resuscitate you within a few minutes to harvest your organs?

Regardless of what they call it, you will be approached as we were, “we understand you want Jamie’s heart to stop beating before organ transplant?”

No you are not getting his organs in any way shape or form, now please leave his room, can’t you see, we are praying over him?”

“Critics, however, call DCD ghoulish and raise the specter of transplant surgeons preying on dying patients. Doctors, nurses and bioethicists who hold this view fear the medical system will give up on potential donors in their final days or even possibly speed their deaths by giving them anti-clotting medication or other organ-preserving drugs, which could hasten death.” Washington Post, Rob Stein, 9/13/07

It’s just TV

Do I dare say that many American’s adopt their values and belief’s from TV? Yes I will say it because unfortunately it is true.

I cried when watching Grey’s Anatomy, because I felt the mother’s anguish when her son died.

Flickr Photo Credit

Archives For Grey’s Anatomy