Brain death Totally Explained

Everything about Brain Death totally explained

Brain death is a legal definition of death that emerged in the 1960s as a response to the ability to resuscitate individuals and mechanically keep the heart and lungs working. In simple terms, brain death is the irreversible end of all brain activity (including involuntary activity necessary to sustain life) due to total necrosis of the cerebral neurons following loss of blood flow and oxygenation. It shouldn't be confused with a persistent vegetative state.

Legal history

Traditionally, both the legal and medical communities determined death through the end of certain bodily functions, especially respiration and heartbeat. With the increasing ability of the medical community to resuscitate people with no heart beat, respiration or other signs of life, the need for a better definition of death became obvious. This need gained greater urgency with the widespread use of life support equipment, which can maintain body functions indefinitely, as well as rising capabilities and demand for organ transplantation.
In the U.S., an ad hoc committee at Harvard Medical School published a pivotal 1968 report to define irreversible coma. The Harvard criteria gradually gained consensus toward what is now known as brain death. In the wake of the 1976 Karen Ann Quinlan controversy, state legislatures moved to accept brain death as an acceptable indication of death. Finally, a presidential commission issued a landmark 1981 report — Defining Death: Medical, Legal, and Ethical Issues in the Determination of Death.

— that rejected the "higher brain" approach to death in favor of a "whole brain" definition. This report was the basis for the Uniform Determination of Death Act, which is now the law in almost all fifty states.
Today, both the legal and medical communities use "brain death" as a legal definition of death. Using brain-death criteria, the medical community can declare a person legally dead even if life support equipment keeps the body's metabolic processes working. The first nation to adopt brain death as a legal definition of death was Finland in 1971. In the United States, Kansas enacted a similar law earlier.

Religion

Despite the adoption of whole brain criteria in the United States and "brainstem" criteria in the United Kingdom, there has been opposition to brain death criteria from the beginning. Traditionalist Orthodox Jews have staunchly defended the traditional conception of death in the U.S. and Israel. Conversely, some modern Orthodox rabbis and Israel's Chief Rabbinate have adopted determinations of death based on brain function. As a result, Orthodox Jewish ethics has been sharply divided over key death-related policies. Tactically, Orthodox Jewish opponents to brain death have requested waivers from state law, as a matter of religious freedom, so as to continue relying on traditional indicia.
The 1981 federal report, Defining Death, found that Catholic and Protestant theologies didn't object to brain death criteria. Indeed, Dennis Horan, president of the pro-life group American Citizens United for Life, stated:

Legislation limiting the concept of brain death to the irreversible cessation of total function of the brain, including the brain stem, is beneficial and doesn't undermine any of the values we seek to support.

More recently, the findings of the 1981 President's Commission Report have been questioned. The new attack on brain death criteria has been multi-pronged. First, the view that brain death marks the end of the integrated unity of the human organism has been questioned. Alan Shewmon has argued that the body as a whole is the central integrator of the organism rather than the brain. He appeals to, among other reasons, brain dead pregnant women who have lived up to 200+ days and given birth to healthy children, as well as to a brain dead boy who lived over fourteen years on a ventilator and with basic nursing support. Others have argued that there's insufficient evidence that the entire brain is dead in a brain dead individual. Some brain dead individuals have continuing EEG activity and others maintain normal or near-normal body temperature, implying continuing hypothalamic function.
   In Catholic medical ethics, Pope Pius XII stated that death is determined by medical experts and it "does not fall within the competence of the Church." Advocates of brain death criteria have claimed that this implies that the church is bound to support the view of the medical community on this issue. More recently, the Pontifical Academy of Science has upheld Catholic doctrine. Nevertheless, there was some Catholic dissent on neurological criteria for death. In addition, a volume consisting of essays by opponents of brain death criteria who participated in a 2005 conference at the Pontifical Academy of Sciences was published in 2006 by a publisher outside the Vatican. questions this presumption. However, since he was declared dead only a few hours after presentation, he didn't yet meet the American Academy of Neurology's brain death criteria.
   While Dunlap was being disconnected from life support four hours after the pronouncement, one of his cousins, Dan Coffin, who is also a nurse, found he was responsive to pain, demonstrating that he was alive,
   so this example is questionable.

Organ donation

organ transplantation is done in the setting of brain death. In some nations (for instance, Belgium, Brazil, Poland, Portugal and France) everyone is automatically an organ donor, although some jurisdictions (such as Singapore) allow opting out of the system. Elsewhere, consent from family members or next-of-kin is required for organ donation. The non-living donor is kept on ventilator support until the organs have been surgically removed. If a brain-dead individual isn't an organ donor, ventilator and drug support is discontinued and cardiac death is allowed to occur.

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