Brain Death

Limited data are available for outcomes of simultaneous liver-kidney (SLK) transplantation using donation after cardiac death (DCD) donors. The outcomes of 12 DCD-SLK transplants and 54 SLK transplants using donation after brain death (DBD) donors were retrospectively compared. The baseline demographics were similar for the DCD-SLK and DBD-SLK groups except for the higher liver donor risk index for the DCD-SLK group (1.8 6 0.4 versus 1.3 6 0.4, P 5 0.001). The rates of surgical complications and graft rejections within 1 year were comparable for the DCD-SLK and DBD-SLK groups. Delayed renal graft function was twice as common in the DCD-SLK group. At 1 year, the serum creatinine levels and the iothalamate glomerular filtration rates were similar for the groups. The patient, liver graft, and kidney graft survival rates at 1 year were comparable for the groups (83.3%, 75.0%, and 82.5% for the DCD-SLK group and 92.4%, 92.4%, and 92.6% for the DBD-SLK group, P 5 0.3 for all). The DCD-SLK group had worse patient, liver graft, and kidney graft survival at 3 years (62.5%, 62.5%, and 58.9% versus 90.5%, 90.5%, and 90.6%, P 5 0.03 for all) and at 5 years (62.5%, 62.5%, and 58.9% versus 87.4%, 87.4%, and 87.7%, P < 0.05 for all). An analysis of the Organ Procurement and Transplantation Network database showed inferior 1-and 5-year patient and graft survival rates for DCD-SLK patients versus DBD-SLK patients. In conclusion, despite comparable rates of surgical and medical complications and comparable kidney function at 1 year, DCD-SLK transplantation was associated with inferior long-term survival in comparison with DBD-SLK transplantation.

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The aim of this study was to explore healthcare professionals' experiences and gain a deeper understanding of interactions with families when approaching the subject of organ donation. A hermeneutic phenomenological approach was used to explore the participants' experiences. Data were collected through a combination of observation and in-depth interviews with nurses, physicians and hospital chaplains recruited from two intensive care units (ICUs) in a Norwegian university hospital. A thematic analysis was used to analyse the data, and three main themes emerged from this analysis: crucial timing, challenging conversations and conflicting expectations. The results revealed that the situation was of a sensitive nature and that finding the best possible time to address the issue in a meaningful manner was a challenge. Respect for the patients' wishes and the families' decisions were an expressed value among the participants, but conflicting expectations about bringing up the subject were also present. This study contributes to the understanding of healthcare professionals' challenges when they are facing brain death as an inevitable outcome of a patient's clinical condition and must approach families on the subject of organ donation.

Il problema mente-cervello: la morte e il concetto di morte cerebrale. Ricerche empiriche, filosofiche e bioetiche 1. Genesi, motivazioni e nascita del lavoro, oggetto di studio: Finalità del lavoro: Il presente lavoro si propone come tentativo di comprensione e approfondimento delle questioni relative al cervello umano nel rapporto tra la vita e la morte, dei problemi che riguardano la morte umana, in particolare, il concetto di morte cerebrale, e delle implicazioni bioetiche che derivano da questo concetto.

Diretrizes para avaliação e validação do potencial doador de órgãos em morte encefálica ABSTRACT causes of this disproportion are errors in the identification of potential organ donors and in the determination of contraindications by the attending staff. Therefore, the aim of the present document is to provide guidelines for intensive care multi-professional staffs for the recognition, assessment and acceptance of potential organ donors.

The purpose of this study was to investigate the feasibility of cardiac microdialysis for the in vivo estimation of cardiac interstitial peptide concentrations, and, to determine the changes in neuropeptide Y release in myocardial tissue during experimental brain death in pigs. Using a specifically designed concentric flexible probe, perfused with Ringer solution containing 0.5 ~o of bovine serum albumin at a flow rate of 2/A/min, allowed us to obtain a 23 + 2?o relative recovery rate in vitro. Based on these in vitro recovery data, a regional study of the kinetics of interstitial NPY levels following brain death was obtained by monitoring the changes in NPY dialysate levels recorded from dialysis probes implanted into the right and left ventricular walls of the beating heart in vivo. Basal dialysate NPY levels determined by radioimmunoassay were of 95.2 + 7.0 and 93.2 + 9.1 pmol/1 in left and right ventricle, respectively. Brain death was followed by a sustained 2 h increase in NPY dialysate levels in both ventricles (peak levels: 173.2 + 30.9 pmol/1 in left ventricle, and 149.7 + 23.9 pmol/1 in right ventricle), which then returned to control levels.

Recently in Latin America, there has been a strong influence of the "Spanish model" of organ procurement. In 2001, The "Punta Cana Group" was created by Latin American transplantation coordinators with the objective of registering and improving the system of donation and procurement. In many countries there is no universal financial support from the government for medical treatment, including dialysis and transplantation. In other countries there is complete financial support for all of the population, including immunosuppressive drugs. Practically all countries have transplantation laws that follow ethical concepts, such as brain death diagnosis criteria, forms of consent, criteria of allocation, and inhibition of commerce. The rate of potential donors notified in countries that perform transplantations with deceased donors varied from 6 to 47 per million population yearly (pmp/y);

This report explores the relationship between philosophy and medicine in the U.K. We note that medical training involves very little formal instruction in philosophy and ethics, and that, with few exceptions, philosophers in the U.K. do not contribute to the instruction of physicians or the philosophy of medicine. However, reviewing the problems arising out of recent developments within scientific medicine we find a pressing need for future philosophical analysis in the following areas: psychiatry, organ transplantation, abortion, euthanasia, experiments on living subjects, consent, confidentiality, the relationship between medicine and political authority, and the provisions for social justice in medicine.

An argument for upper-brain death or death of the conscious mind as the preferable definition of "human death" as opposed to the standard (lower) brainstem death, which focuses on the loss of autonomous breathing and certain other autonomic reflexes. The argument is made both from a scientific as well as a Jewish Law perspective.

La mort encéphalique (ou mort cérébrale) peut être définie comme la perte des fonctions du cerveau. L'assimilation légale de la mort cérébrale à la mort a fait l'objet de nombreuses controverses dans la littérature bioéthique depuis 40 ans. Dans ce travail, j'explore la notion de mort cérébrale, son origine historique et la situation actuelle des controverses sur ce sujet. Premièrement, j'essaye de clarifier le concept de mort cérébrale et de me placer à l'origine de ce concept, soulignant l'importance de la mort cérébrale dans la médecine actuelle. Deuxièmement, je montre quelques particularités des régulations internationales sur la déclaration de la mort et le prélèvement d'organe. Cela servira à comprendre comment le diagnostic de la mort n'est pas une pratique universellement homologuée. Finalement, me basant sur quelques études empiriques qui ont été menées sur ce sujet, je montre comment la mort cérébrale continue à poser des problèmes de compréhension parmi les citoyens et même parmi les professionnels de santé susceptibles de prendre en charge ce type de patients. Mots-clé: mort encéphalique, prélèvement d'organes, bioéthique, approche internationale, approche historique, approche empirique. Concept et origine de la mort cérébrale On définit la mort cérébrale comme étant la perte des fonctions du cerveau. Dans la plupart des pays développés, cette condition est légalement équivalente à la mort. L'idée de « mort cérébrale » est née vers la fin des années soixante, suite au progrès des techniques de réanimation cardio-pulmonaire. En effet, si des respirateurs automatiques n'avaient pas été appliqués aux patients dont le cerveau avait été sévèrement endommagé par un traumatisme ou un accident cérébral, cette notion n'aurait jamais vu le jour. Il peut paraître étrange qu'un progrès technique ait conduit à la révision des critères classiques du diagnostic de la mort humaine. Comment cela at -il été possible ? On considérait traditionnellement que les seules fonctions responsables de la vie humaine étaient la circulation et la respiration, car l'interruption de l'une entraînait irrémédiablement celle de l'autre. La perte de n'importe laquelle de ces fonctions était irréversible et signifiait la mort de l'individu. De plus, avant que les mesures de réanimation ne soient mises en place, les personnes souffrant d'un dommage cérébral sévère perdaient automatiquement leurs fonctions cardio-respiratoires. Pour cette raison, le fonctionnement du coeur et des poumons semblait être nécessairement lié au fonctionnement du cerveau. Mais les méthodes de réanimation ont ensuite prouvé le contraire. La réanimation cardiaque, d'un côté, démontrait que l'arrêt du coeur était parfois réversible. La ventilation mécanique, de l'autre, permettait de maintenir artificiellement la fonction respiratoire chez des patients dont le cerveau était détruit. L'une des conséquences de l'utilisation de ces techniques fut l'apparition de patients irréversiblement inconscients dont l'organisme continuait malgré tout à fonctionner (grâce au maintien de la respiration assistée). Au début de 1959, Wertheimer, Jouvet et Descortes décrivirent pour la première fois cet état

In this chapter I try to explore many problematic aspects linked to organ transplantations and the end of life. This is a good opportunity to verify what law, scientists, and philosophers think about the Determination of Death (especially about Brain Death) and the are the most important problems connected to consent for organ donation; finally, Catholic point of view on organ donation will be analyzed too.

A 45 year old male working as a labourer in the agricultural sector was brought to the emergency room with complaints of difficulty in opening the eye-lids, dysphagia, dysphonia, dyspnea, and progressive weakness in all four limbs, after awakening from sleep. At presentation, patient had no spontaneous respiratory efforts and was deeply cyanosed. Endotracheal intubation was performed immediately and the patient was mechanically ventilated. Physical examination revealed an afebrile patient with a heart rate of 130 beats/ minute and blood pressure of 160/100 mm Hg. He was comatose with absent motor responses to painful stimuli, complete ptosis, external, and internal ophthalmoplegia. Deep tendon reflexes and plantars were absent. Fang marks typical of snakebite were noted in the right middle finger. Patient was started on anti-snake venom (Haffkine Institute, Mumbai) at a dose of 100 mL stat followed by 50 mL at 6 hours, deep venous thrombosis and stress ulcer prophylaxis along with supportive care. Arterial blood gas analysis, serum electrolytes, liver, and renal function tests done were within normal limits. After initiation of ventilatory support, patient's heart rate and blood pressure returned to normal limits, and he was maintaining normal oxygen saturation on pulse oximetry, however, there was no improvement in neurological status in the next 8 hours, and a possibility of brain death secondary to prolonged hypoxia prior to hospitalisation was being considered. Patient was unresponsive to tracheal suctioning; pupillary, corneal, and oculocephalic reflexes were absent and the cold caloric test was negative. However, approximately 12 hours after presentation, patient was noted to have triggered breaths on the ventilator and in the next 72 hours, patient had recovery of all the neurological functions. He was extubated and discharged with no neurological sequelae.

Support Vector Machine (SVM) is one of the popular Machine Learning techniques for classifying the Electroencephalography (EEG) signals based on the neuronal activity of the brain. EEG signals are represented into high dimensional feature space for analyzing the brain activity. Kernel functions are helpful for efficient implementation of non linear mapping. This paper gives an overview of classification techniques available in Support Vector Machine. This paper also focus role of SVM on EEG signal analysis.

Organisms', materialism, 'consciousness', and moral statusproblems in Lamb Lamb defines death as 'the irreversible loss offunction of the organism as a whole' (9). His account then goes on to claim that loss of brainstem function is sufficient to

There are not enough solid organs available to meet the needs of patients with organ failure. Thousands of patients every year die on the waiting lists for transplantation. Yet there is one currently available, underutilized, potential source of organs. Many patients die in intensive care following withdrawal of life-sustaining treatment whose organs could be used to save the lives of others. At present the majority of these organs go to waste.

This article will examine the claims offered by both sides of the debate as to whether Brain Death definition was linked to Organ Transplantion needs by looking at historical studies on the relationship between them, either establishing such a link or rejecting it. In the last section, the role of Henry Beecher as the Committee chairman will be highlighted to put this debate in a proper perspective. Beecher is widely known for his role as a whistleblower of unethical experimentations on human subjects in the 1960s. His concerns for ethical behavior for scientists and physicians had an important impact on the Harvard committee, a role which has often been ignored.

Clinical assessment of consciousness in the acute setting is of considerable importance. Precisely determining severity of consciousness alteration allows not only establishing vital and functional prognosis but also to follow efficiently the clinical evolution of brain damaged patients and to optimize resources use. In the present article, we review the main coma scales. We particularly focus on a recently published tool, the ''Full Outline of UnResponsiveness'' (FOUR) Scale. This new scale represents indeed a major advance in the clinical assessment of patients suffering from consciousness disorder. Among the significant improvement brought by this scale, one can mention its ability to contribute to the diagnosis of locked-in syndrome, minimally consciousness state or brain death. We think that, regarding its clinical input at the acute setting of consciousness disorders, the FOUR Scale should be preferred to the classic Glasgow Coma Scale.

Esiste un confine certo tra vita e morte? Il volume ripercorre, con un approccio transculturale, la storia della definizione di morte e le vicende connesse alle tecniche di accertamento del decesso dall'antichità ai giorni nostri. Da sempre, infatti, medici, filosofi e teologi si sono sforzati di individuare il momento preciso dell'exitus, l'istante in cui, secondo la tradizione, l'anima avrebbe lasciato il corpo. Nondimeno, soglie e parametri stabiliti da una generazione furono spesso posti in discussione e ridisegnati dalla successiva. Alimentato dai successi conseguiti nelle tecniche rianimative e nella trapiantologia, il dibattito ha conosciuto una fase di grande vivacità proprio negli ultimi decenni, tanto che, pur avendo in genere abbandonato -o, perlomeno, ridimensionato -considerazioni su principi metafisici, la definizione di morte appare ancor oggi come un oggetto di negoziazione scientifica e bioetica.

Hans Jonas e la questione della morte cerebrale. A proposito di una recente ristampa. di Andrea Marziani Nel 2008 sulla Rivista internazionale di filosofia del diritto è apparsa una discussione critica del volume di Paolo Becchi Morte cerebrale e trapianto di organi. Una questione di etica giuridica (Morcelliana, 2008) ad opera di Paolo Pasqualucci 1 . Successivamente nel 2011 sulla medesima rivista lo stesso Becchi, continuando un dialogo ideale con Pasqualucci, pubblica la trascrizione di una conferenza tenuta a Padova nel marzo scorso intitolata Morire dopo Harvard 2 , titolo di un volume a sua cura edito nel 2009 da Morcelliana in cui si ripropone il saggio di Hans Jonas Controcorrente (Against the Stream) oggetto del mio intervento, con cui vorrei contribuire al dialogo. Fin dalla sua prima apparizione nel 1970 il saggio di Jonas è riuscito a ritagliarsi una posizione singolare nella storia della riflessione filosofica sulla morte cerebrale. Inascoltato dapprima in ambito medico, giuridico ed etico e poi sconfitto sul piano politico, è rimasto però presente nel dibattito come luogo di confronto obbligato per chiunque si avvicinasse al tema specifico della morte secondo criteri neurologici. Se poi guardiamo agli sviluppi della riflessione scientifica ed etica, soprattutto negli ultimi tempi (pensiamo alle recenti posizioni del Council on Bioethics statunitense 3 ), non possiamo non riconoscere al filosofo tedesco una notevole capacità predittiva ed una profonda acutezza nell'aver saputo cogliere gli aspetti salienti e problematici dell'articolo, ormai divenuto un classico della letteratura medico-scientifica e bioetica: A Definition of Irreversibile Coma dell'Ad Hoc Committee dell'Harvard Medical School del 1968 4 . L'argomento di Jonas è noto: è del tutto contro intuitivo ritenere morto e dunque cadavere l'essere umano nello stato di «morte» cerebrale, a causa delle sue condizioni fenomeniche che lo distinguono in tutto e per tutto da un cadavere. La nuova definizione di morte non sarebbe, tuttavia, problematica, e forse necessaria, se il suo scopo fosse unicamente quello di permettere al medico la sospensione della terapia intensiva, che mantiene in vita biologica il paziente. In tal caso non si tratterebbe di una definizione nuova, ma di nuovi criteri, più raffinati, per monitorare le possibilità di recupero del paziente o la sua inevitabile discesa verso la morte. Tale definizione che si fonda sulla sola attività cerebrale come unico indice rilevante, secondo Jonas, non darebbe diritto di agire sul corpo del paziente come si agirebbe su un cadavere, né di iniziare la procedura di prelievo di organi, proprio perché non si sarebbe di fronte ad un morto. Ciò che colpisce immediatamente l'attenzione di Jonas sono i motivi che hanno spinto alla formulazione di una nuova definizione di morte. Motivi non inerenti, ossia non dettati dall'inesattezza o insufficienza della «vecchia» definizione, ma ragioni esplicitamente eteronome: «liberare pazienti, congiunti e risorse mediche dal peso di un coma indefinitamente protratto ed evitare controversie sul reperimento di organi per trapianti» (pp. 40-41). Se, infatti, l'intervento tecnologico dei macchinari di rianimazione ha creato la possibilità di recuperare numerosi pazienti, che in seguito ai traumi subiti sarebbero morti, tale intervento ha anche permesso la creazione di condizioni che in precedenza non sarebbero state possibili. Esso ha reso possibile sospendere il paziente per un periodo di tempo indefinito in uno stato intermedio e ambiguo, rendendo stabile una condizione altrimenti 1 P. Pasqualucci, Se la "morte cerebrale" non è la vera morte, sono legittimi i trapianti? A proposito di un recente libro di Paolo Becchi, in «Rivista internazionale di filosofia del diritto», 4, 2008, pp.673-700. 2 P. Becchi, Morire dopo Harvard, in «Rivista internazionale di filosofia del diritto», 3, 2011, pp.273-287. 3 Nel 2008 il presidente del Council of bioethics ha operato un cambiamento terminologico significativo sulla morte cerebrale passando da Total Brain Death a Total Brain Failure. 4 A Definition

"Israeli Bioethics: Challenges in Designing Public Health Policy in Israel - A Jewish and Democratic State", 34th Annual Meeting of the Association for Israel Studies - "Israel at Seventy: Challenges and Opportunities", university of California, Berkeley, June 25-27, 2018

By the beginning of the 1980s, deliberations on Islam and biomedical ethics started to assume a systematised and collective form through combining contributions from Muslim religious scholars and (Muslim) biomedical scientists. The original idea was that biomedical scientists would inform and educate Muslim religious scholars about the scientific and biomedical aspects of specific bioethical issues. After being equipped with sufficient information about these technical aspects, religious scholars would embark upon their normative role by construing the religio-ethical Islamic standpoint. This proposed strict division between the tasks of biomedical scientists and those of religious scholars did not prove to be viable during the gatherings which hosted both groups. Instead of confining themselves to the informative role, biomedical scientists infringed upon the normative role which is typically assigned to Muslim religious scholars alone. Besides presenting technical information, they also presented their own perspectives on how Islamic scriptures should be employed in order to develop the Islamic religio-ethical standpoints. This article explains how biomedical scientists moved from being just “informants” for the religious scholars to becoming eventually “co-muftis”.


Розвиток медицини і науково-технічний прогрес призвели до перегляду ставлення людини до смерті. Більшість із порушених етичних проблем виявилися безпосередньо пов'язані з визначенням і критеріями смерті, а також із розробленням тестів, що дозволяють встановити її факт.
Історія концепції смерті мозку - від опису окремого клінічного випадку «позамежної коми» до появи і нормативно-правового закріплення принципово нового критерію, є однією з найважливіших подій сучасної культури.
Саме у руслі розвитку критерію і концепції смерті мозку, в проблемному просторі біоетики зароджується нове поняття смерті як єдиного, змістовного процесу старіння, вмирання і припинення існування людини.


Development of medicine and scientific and technological advance led to revision of person’s attitude to death. Majority of opened ethics subjects were directly connected with determination and criteria of death, and also with development of tests which allow to determine that fact.
History of conception of brain death - from description of the special clinical case of «coma dépassé» to appearance and legal fixing of principle new criterion, is one of major events in modern culture.
Exactly in the way of criterion development and conception of brain death, in problem space of bioethics the new concept of death is engendered as the unique, substantial process of senescence, dying and stopping of human being.

Should a theory of justice that yields universal principles for the allocation of goods be sensitive to cultural differences, and should there be a limit to the respect for cultural and religious diversity? I address this question from a liberal point of view and more specifically based on the Sen-Nussbaum capability approach. Three possible arguments within this approach are analyzed: dignity, internalist essentialism, and positive freedom. The interplay between a universal principle of distribution and respect for cultural and religious diversity is demonstrated by using a particular version of the capability approach that is applicable to the health care sphere, namely the Sufficiency of Basic Human Functional Capabilities. I discuss the account's commitment to a universal allocation principle and its respect for cultural and religious diversity, and demonstrate the possible tension between them using two examples: treatment of congenital strabismus and the definition of death as a prerequisite for organ removal. It is shown that liberals can present and defend universal principles of justice if they can clearly define what the universal principles for justice require and if they can provide strong justification for these universal claims. I argue that by means of the same argument in favour of respecting cultural diversity, liberals can justify not respecting it under certain circumstances.It is shown why these circumstances apply

In this article the practice of end of life decisions is applied to pregnant women. This is not an easy task as shown by the extensive case law and literature on the subject. The main conclusion of the article is that the pregnant woman's wishes should always be respected whatever the consequences for the foetus may be. Another position would unjustly sacrifice the woman's fundamental rights to bodily integrity and self-determination for the benefit of a non-person. The result is repeated in the situation where the woman is found to be incompetent or brain dead.

Consciousness is now one of the central strands in the neuroscience agenda. The current interest in chronic vegetative states, and the ways that consciousness can be enhanced by peripheral and cortical stimulation, suggest that we may have to re-think the mechanisms of coma. A recent paper (Rosenberg 2009), looking at consciousness, coma and brain death, draws together the current strands of neuroscience thinking. However, he is very bold when claiming that &#x27;There is no separate mind from the brain, the mind is the brain. Cartesian logic of a separate mind and brain is an archaic philosophical concept, displaced by current functional magnetic resonance imaging, deep brain stimulation studies, years of meticulous neuropathologic studies, and experimental neurophysiological animal studies that have proven that consciousness and mind are embedded into specific neuro-anatomical arousal behavioural circuits… It is now clear that coma, consciousness and cognition are neural-directed ...

If there is one issue that unites virtually all sides in the fractious halakhic debate over brainstem death, it is the critical significance of the position of R. Moshe Feinstein.  R. Feinstein was one of the earliest posqim to weigh in on this issue, and one of a very few with sufficient stature to potentially resolve the debate. That his position has become the subject of intense dispute is thus particularly unfortunate. Since his death in 1986, a remarkable amount of energy has been exerted by proponents in both camps toward posthumously ‘recruiting’ R. Feinstein to their side of the issue.
Despite the fact that R. Feinstein’s responsa have been picked over endlessly in the course of the debate, there remain not only a number of persistent misconceptions about his position, but also several passages that scholars on both sides have virtually ignored. In this article, I argue that R. Feinstein’s position is fully consistent with the standard of brainstem death currently accepted by the medical community, and that the passages which scholars have overlooked provide important conceptual grounding for that position. I further propose that the outsized attention accorded to Rabbi Feinstein’s position is justified not only by his inestimable status as a poseq, but also by his extremely incisive analysis of this issue. Both in his conceptual analysis and in his use of sources, R. Feinstein challenges the deeply ingrained views that have that come to dominate the debate over brainstem death and medical halakha in general.