Is Brain Dead Really Dead - Research Paper Example

Is “Brain Dead” Really Dead? Affiliation Brain death is a clinical manifestation characterized by irreversible cessation of all the functions of the human brain, including the brain stem. Irreversible cessation of brain functions has been used as the clinical basis for certifying death. The process of determining brain death is complex and is thus required to be done by specialist doctors who possess experience in diagnosis. Recognition of brain death is crucial in medical practice given the medical, bioethical and legal contestations associated with brain death. Traditionally, permanent cessation of the respiratory and cardiovascular functions was relied on to determine death. Advances in medical knowledge and practice have made it possible for respiratory and cardiovascular functions to be taken over by sophisticated machines and advanced therapies. The significance of recognizing brain death is based on the costs of maintaining patients on life support, intellectual progression and utilitarian purposes. Despite the importance of recognizing brain death, concerns have been raised over challenges to determining brain death. The first challenge is that brain death is not death while the second challenge is that brain death is death but the clinical criteria used to recognize it are unreliable. This essay will discuss the importance of recognizing brain death, in addition to discussing the challenges to brain death. Keyword: Brain death, irreversible cessation, brain functions Is “Brain Dead” Really Dead? Brain death is a clinical manifestation characterized by irreversible cessation of all the functions of the human brain, including the brain stem (Machado, 2007). Even though the concept of brain death has commonly been applied to organ donation and transplantation, brain death has become a contested issue in general medical practice. Strict guidelines have been developed to certify brain death and only specialist medical practitioners are allowed to make the determination. Recognition of brain death is crucial in medical practice given the medical, bioethical and legal contestations associated with brain death. Much as brain death is considered to be effective in making definite recognition of death, the legal, ethical and human aspects associated with death make brain death a very complex clinical issue. Determination of Brain Death The permanent cessation of the respiratory and cardiovascular functions was traditionally used as the basis upon which death was recognized. Regardless of a patient’s situation, this criterion was widely accepted as the standard for recognizing death (Wijdicks, 2013). Conversely, advancements in medical technology and knowledge have rendered these two vital functions less important to recognize death. In essence, respiratory and cardiovascular functions can now be supported and taken over by sophisticated machines and advanced therapies (Machado, 2007). Within this context, traditional definition of death is deemed inappropriate and thus necessitating a different technique to determine death. Generally, death indicates irreversible cessation of the coordinated functions of the body as a whole. The use of respiratory and circulatory functions as determinants of death is justified in the sense that the irreversible cessation of these two vital signs causes the inevitable and irreversible cessation of brain functions (Machado, 2007). The brain has been identified as a crucial organ that determines whether body organs will function or not. In contrast to other body functions, the critical role of the brain in receiving, processing and responding to stimuli cannot be performed by machines (Wijdicks, 2013). According to Shappel et al. (2013), the brain ultimately determines the distinction between life and death because it is the nerve center of vasomotor, hormonal, respiratory, neurotransmitter and neural functions. Importance of Recognizing Brain Death Basically, brain death simply means that a person is identified ad dead following an examination of the nervous system (Wijdicks, 2013). Determination of death based on irreversible cessation of brain functions is limited to ICU patients. Determination of brain death is necessitated by numerous factors. To begin with, it is important to determine brain death on grounds of ethics and good medical practice. It is costly to treat ICU patients and the number of ventilators and ICU beds are limited. Therefore, it is both economically and morally unjustified to keep brain dead patients on life support at the expense of those who have better prognosis (Machado, 2007). Secondly, doctors certify death by brain death meaning that patients are always unresponsive, unreceptive and immobile. However, these indicators are often taken for granted by physicians. In certifying death, doctors usually examine respiration, pulse and heart beat and may perform an ECG in other cases. If convinced of the absence of respiratory and cardiovascular functions, the doctor then examines the pupils. Pupils that are fixed and un-reactive (normally dilated) confirm diagnosis of death (Machado, 2007). As already noted, absence of cardiovascular and respiratory functions heralds the inevitable irreversible cessation of brain function. Based on the sequence of procedures followed by doctors to certify death, recognition of brain death becomes a matter of intellectual progression (Shappel et al., 2013). Thirdly, recognition of brain death is important for utilitarian purposes. The costs associated with the management of ICU patients, coupled with the high demand of life support machines for patients with better prognosis makes recognition of brain death important on ethical grounds (Machado, 2007). Determination of death has traditionally been determined on the basis of possible organ donation. Organ transplantation is now widely accepted treatment for chronic organ failure thus requiring doctors to respond with utmost care. The survival of a donated organ is assured when taken from a brain dead patient prior to circulatory collapse. Determination of brain death becomes a fundamental step for cadaveric organ transplantation (Wijdicks, 2013). The irreversible cessation of brain functions is accounted for by sufficiently severe brain injury. Specialized radiological investigations, such as CT scans, are usually used to determine severe brain injury. During these investigations, doctors are required to determine with certainty that neurological dysfunction has not been caused by metabolic conditions or effects of medication. Doctors must then independently determine irreversible brain damage by confirming complete unconsciousness and loss of all reflex functions associated with eye movement, gagging, coughing, papillary responses and blinking. When the patient has been disconnected from mechanical respirator, careful observations are needed to determine complete absence of breathing attempts (Machado, 2007). Brain death is considered a definite clinical manifestation. Irrespective of the medication administered, adult patients who have suffered brain death will develop asystole in a week. Various angiographic studies have shown absence of blood flow in brain death. Furthermore, diffuse swelling with foraminal and tentorial herniations has been observed through magnetic resonance imaging (Wijdicks, 2013). Documented cases of brain death in over 2,000 patients indicate that none of the patients survived. Postmortem tests have indicated swollen and soft brain hemisphere and stem, with brain lodged fragments in the spinal cord. Postmortem tests also indicate widespread necrosis. The postmortem results from brain dead patients are totally inconsistent with life (Machado, 2013). Challenges to Brain Death Criterion Despite the importance of recognizing brain death, there are two challenges to determining brain death. The first contestation is that brain death is not death. Brain death is determined on the basis of irreversible cessation of brain functions. However, technology has made it possible for a brain dead body to continue manifesting many of the physical signs of life. Life and death are visible signs; a body indicating sufficient evidence of life and organic organization cannot be rendered dead. In the traditional and ordinary sense, a body a dead brain patient which can be kept alive for long durations cannot be certified as dead. While some may argue that a warm body of brain dead patient is a clear indication of life, others argue that life is more than interconnections of warm and functioning organs (Bernat, 2013). The second contestation is that brain death is death but current clinical criteria used to recognize it are not reliable. The “irreversible” loss of brain functions has always been a major area of contestation. Patients fulfilling brain death criterion based on current clinical assessment may retain neuroendocrine activity, as well as inducible and spontaneous electrical activity. With well-thought medical management, brain dead patients can be kept on artificial support and mechanical ventilation for considerable periods of time. On this basis, brain death is construed to imply that death has not occurred but will occur in the near future (Bernat, 2013). Shappel et al. (2013) have identified invariabilities in brain death criteria across practice which has been brought about by lack of consensus on what constitutes brain death. Conclusion Brain death is a very crucial phenomenon in clinical practice on various accounts. First, recognition of brain death ensures that patients with better prognosis benefit from the limited healthcare resources. Second, recognition of brain death is a critical factor in organ transplantation with regards to the success of the procedure. Whereas it is crucial to recognize of brain death, current contestations make the procedure complex and difficult. A brain dead patient may not be dead on account of life support which can extend the patient’s life. Furthermore, brain dead patients may retain activity, meaning that brain death diagnosis is an indicator death in the near future. Much as recognition of brain death is crucial in clinical practice, the challenges to brain death must be considered during the course of making a diagnosis. References Bernat, J. L. (2013). Controversies in defining and determining death in critical care. Nature Review Neurology, 9(3). 164-173. Machado, C. (2007). Brain death: A reappraisal. New York, NY: Springer Shappell, C. N., Frank, J. I., Husari, K., Sanchez, M., Goldenberg, F., & Ardelt, A. (2013). Practice variability in brain death determination: a call to action. Neurology, 81(23), 2009-2014. Wijdicks, E.F. (2013). Brain death. Handbook of Clinical Neurology, 118, 191-203. Read More