$Unique_ID{BRK01529} $Pretitle{} $Title{What Are the Conditions That Make a Person "Brain Dead"?} $Subject{brain dead determination determine determining central Nervous System death brain-dead spinal cord reflex intoxication intoxicated overdose overdoses organs neurologists neurosurgeons anesthesiologists brain-death life living} $Volume{F-1} $Log{} Copyright (c) 1991-92,1993 Tribune Media Services, Inc. What Are the Conditions That Make a Person "Brain Dead"? ------------------------------------------------------------------------------ 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. ------------------------------------------------------------------------------ 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. ---------------- 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.