$Unique_ID{BRK01529}
$Pretitle{Nervous System and Sense Organs}
$Title{What Are the Conditions That Make a Person "Brain Dead"?}
$Subject{brain dead determination}
$Volume{F-1}
$Log{}

Copyright (c) 1991   Tribune Media Services, Inc.


What Are the Conditions That Make a Person "Brain Dead"?


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QUESTION:  Can you please tell me what are the conditions that make a person
"brain dead".  I believe that this is the situation that is necessary for the
organs to be donated, and my family needs some information to make a most
important decision.

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ANSWER:   In actual practice, it means that the heart beat and respiration can
be maintained artificially, giving the appearance of life, long after the
brain itself has stopped working and is "dead".
     While determination of death has traditionally been based on the stopping
of breathing and the heartbeat, the development of techniques to support
failing lung and heart functions--even when the brain appears dead--has made
these signs insufficient to determine the death of an individual and most
inadequate under certain circumstances.  So recent criteria for the
determination of death have been based on an assessment of the brain.
     To be declared brain-dead, a patient must meet certain clinical
conditions, including having:  no spinal cord reflex movements; no eye opening
or other movement--either spontaneously or in response to painful stimuli to
the face or trunk; plus other more technical conditions.  The fact is that
determining that a patient is really brain dead is not an easy task, and
sometimes nearly impossible.
     To further complicate matters, there are certain conditions that can
mimic the appearance of brain death, but in reality are something entirely
different.  Examples include cases of extreme intoxication and drug overdoses.
     Yet despite the difficulty, early recognition and declaration of brain
death are important.  Continued treatment of patients who are brain dead can
subject the family to uncertainty and false hopes.  Some people feel that
treating a brain dead patient is an indignity to the patient's body.  Others
say that medical resources should not be expended on treating patients who are
already dead.  Still others contend that so long as a patient's heart is
beating and breath is continuing, that person is alive and deserves any and
all treatments available to the medical profession.
     In an era where organs may be salvaged from patients already brain dead,
the hopes of many individuals whose lives may depend upon such donors are
doomed, as the number of organs remain insufficient to meet the need.  Though
some statistics indicate approximately 20,000 cases per year which might
possibly yield donor organs, only about 2,000 to 3,000 actually do.
     There are also other unresolved issues involved in the declaration of
brain death that remain unsettled.  Some are scientific issues that require
formal investigations.  Others concern social values and public policy and
require debate by ethicists and lawyers.  Additionally, there are questions as
to who should declare a patient to be brain dead. . . should it be
neurologists, neurosurgeons, anesthesiologists, or physicians serving in
intensive care units and emergency departments.  In many institutions it takes
a panel of physicians, with all these areas of expertise to make the final
determination, and if you are facing an important decision of this nature,
consultations with your own physician and the chairman of this committee may
be of great assistance.
ÿ
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The material contained here is "FOR INFORMATION ONLY" and should not replace 
the counsel and advice of your personal physician.  Promptly consulting your 
doctor is the best path to a quick and successful resolution of any medical 
problem.
