Is brain death - death? New Canadian brain-death guidelines

ALEX SCHADENBERG: Is brain death - death? New Canadian brain-death guidelines.: There have been many concerns about whether organ donors are dead before their organs are removed, but the current Canadian guidelines appear to make it more likely that death occurs from the removal of organs rather than waiting for death to occur and then removing organs from a dead donor. National Post article; McGill Journal of Law and Health article

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Organ harvesting in light of questionable ‘brain death’ criterion

Vatican Radio tackles organ harvesting in light of questionable ‘brain death’ criterion | LifeSiteNews.com: The dubious criterion of ‘brain death,’ invented in 1968 to accommodate the need to acquire vital organs in their “freshest” state from a donor who some argue is still very much alive, made headlines two weeks ago when a young British man revealed to the media that he owed his life to his insistent father who would not allow his son’s organs to be removed from his body, despite assurances from four doctors that his son could not recover from the wounds he had suffered in a car accident.

Related:
Rebuttal and response
Making organ donations a thing of the past, British lab grows spare parts

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Critical organ donation warnings and guidance in new pamphlet: “Do not do an Apnea test!”

Critical organ donation warnings and guidance in new pamphlet: “Do not do an Apnea test!” | LifeSiteNews.com: Dr. Paul Byrne has been on a personal mission for many years to warn the public about the alarming facts and dangers of the $20 billion dollar-a-year organ transplant industry. Dr. Byrne has addressed serious concerns regarding so-called “brain death,” the apnea test, and organ transplantation. He also introduced a new 29-page booklet containing crucial information to assist the public in making informed decisions about organ donation.

Editor: He makes this interesting comment about ventilators --

“The ventilator can be effective only in someone living” emphasizes Byrne. “The ventilator pushes air into the lungs; the air goes out (exhaled) only when and because the living body pushes it out. This does not occur in a cadaver/corpse/dead body.”

Related: Rebuttal and response

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Shades of Schiavo: euthanasia case of girl nagging at Mitt Romney

Shades of Schiavo: euthanasia case of girl nagging at Mitt Romney | Naked Politics: On the day Mitt Romney announced the support of social conservatives, the Republican blogosphere buzzed with reports about how a state agency under the former Massachusetts governor tried to pull the plug on a brain-damaged girl who ultimately came out of a coma. The report about Haleigh Poutre surfaced on The Shark Tank blog in a sign that some conservatives – and especially social-conservatives – aren’t comfortable with the Republican frontrunner.

Romney said little about the case at the time, according to news reports. “Gov. Mitt Romney,” The Boston Globe wrote in 2006, “wouldn't directly respond to a question about his stance on the right to die in general, saying in a statement: 'At the present time, my concern is with this young girl and her current status. In light of reported improvements in her medical condition, it should be clear to everyone that no action should be taken to end this girl's life.' "

In a written statement, Romney's campaign says he didn't just stand quietly by: "Gov. Romney criticized the state's handling of the case, ordered an investigation and put in place safeguards to prevent it from happening again. His actions speak for themselves."

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‘Dead-donor’ rule dangerously misleading, experts say

Doctors should abandon the “dangerously misleading” policy of having to declare donors dead before their organs can be extracted for transplant, and adopt a more honest policy that acknowledges some patients may still be technically alive, Canadian and Spanish experts suggest in a provocative new commentary.

They advocate replacing the current “dead-donor rule” with a policy that educates the public about the true nature of patients used in transplant, obtains informed consent — and ensures the donor does not suffer during the organ harvesting.

The authors, including Dr. Neil Lazar, director of the medical-surgical intensive care unit at Toronto General Hospital, say the focus should be on the well-being of donors rather than whether they are legally dead. That could mean giving anesthetics during organ harvesting.

. . . The suggestions, made at a major U.S. bioethics conference last week and in a recent paper in the American Journal of Bioethics, are coming under strenuous criticism by the transplant community, however. Some experts call the proposal a theoretical argument that has little foundation in reality, but that could seriously hurt the ongoing struggle to recruit potential organ donors.

“In the overwhelming majority of cases, the concept of death is easy, obvious and not really subject to any complex interpretation. It’s very clear,” said Dr. Andrew Baker, medical director of the Trillium Gift of Life Network, which oversees Ontario’s transplant system. “They’re dead, you can see it, there is no return of anything.”

. . . In questioning death declaration, the bioethics paper focuses largely on a recent trend in transplantation.
Most transplant organs are taken from patients declared brain dead. Those people account for only about 10% of hospital deaths, however, leaving a shortage of donors and hundreds of gravely ill Canadians languishing and dying on transplant waiting lists.

In response, the medical community has recently embraced a new protocol, where organs are removed after the heart has stopped — in Canada, five minutes after it has halted — but when the patient is not necessarily brain dead. 

. . . While the medical community generally supports “donation after cardiac death [DCD],” there has been some controversy. . . . [I]n most DCD cases, doctors have made a decision not to continue life-support measures that keep the patient breathing and their heart beating. That does not necessarily mean the heart could not be started again, artificially at least, they argue.

It is also possible that when cardiac death is declared, there may still be some brain activity, raising at least the possibility the donor could feel pain during the harvesting of organs, the paper argues. The process of inserting catheters that pump blood through the transplant organs before removal could also start blood circulation in the brain, triggering some limited activity there, the article says.

Dr. Baker said there is no evidence, however, that cardiac death is anything but the complete lack of life. When someone is removed from a ventilator, first they stop breathing, then their heart stops. That means that the brain stem, which regulates those activities and is considered the last part of the brain to die, would have lost all function. And perfusion is done here in a way that there is no blood flow through the brain, he said. National Post

Removal of life support may occur too early in some cases

There are notable differences in mortality rates after traumatic brain injury from hospital to hospital. The results of a new Canadian study have found that those differences may be attributable to individual hospital practices; specifically, how different hospitals handle the removal of life support from such patients.

. . . In a number of cases of death due to withdrawal of life support, death occurred within the first three days of care. In most cases, life support was removed because the patient had a poor chance of survival, poor long-term neurological prognosis, or a prognosis which was not compatible with his or her wishes.
More Information

Though all are legitimate reasons to cease life-sustaining therapy with a patient, researchers warned that some trauma centers may be making these calls too early. Especially given that many traumatic brain injury cases – often the result of car accidents, assaults, etc. – occur in young people whose chances of recovering from such injury are greater than someone who is older, three days of care may not be enough time to give an accurate prognosis.

The authors admitted several limitations to the study, among which was the reliance on patient medical records which may have led to an underestimation of the frequency of life support withdrawal. However, the results leave us with important things to consider. Researchers encourage doctors to communicate frequently with families of severe brain injury patients if removal of life support or life-sustaining therapy may become necessary. Healthwatch MD

‘Brain dead’ Quebec woman wakes up after family refuses organ donation

‘Brain dead’ Quebec woman wakes up after family refuses organ donation | LifeSiteNews.com: 76 year old Madeleine Gauron was hospitalized for an inflammation of the gums, which required a brief operation. During her recovery, hospital staff gave the elderly woman solid food, which she had been unable to consume in her family home for some time, and left her unattended. Choking on the food, she fell into a coma, after unsuccessful resuscitation.

Medical staff contacted her family, explaining to them that their mother was “brain dead,” with no hope of recovery. Citing Gauron’s eyes as particularly viable, the doctors asked if the family would agree to organ donation. While supporting the possibility of donation, her shocked family first demanded further medical tests to prove Gauron was really dead.

The next day, the family was astonished to learn that Gauron had awakened. Shortly afterwards, she sat up in bed and ate yogurt. “If we had decided to donate her organs, they would have killed her,” said her son.

Vital organ donation

Vital organ donation: If you were to compare a dead body with someone declared 'brain dead,' you would find that the dead body is pale, cold, stiff, and unresponsive. There is no heartbeat, no body functions, no breathing, and no movement. Someone declared 'brain dead' is warm and flexible. There is a beating heart, normal color, temperature, and blood pressure. Most functions continue, including digestion, excretion, and maintenance of fluid balance with normal urine output. There will often be response to surgical incisions. In a long enough period of observation, someone declared 'brain dead' will show healing and growth, and will go through puberty if they are a child.

Husband Celebrates as 'Brain Dead' Wife Wakes Up in Hospital

Husband Celebrates Miracle as 'Brain Dead' Wife Wakes Up in Hospital - FoxNews.com: A woman who was diagnosed as being brain dead has recovered three days after her husband begged doctors to put in a breathing tube before switching off a ventilator at an Australian hospital. When a doctor recommended that the ventilator be removed and Gloria Cruz be allowed to die, her husband told them, 'I'm a Catholic -- I believe in miracles. I told him that God knows how much I love her -- that I don't want her to suffer but I don't want her to leave us.” A doctor described her recovery as 'a miracle.'

Experts Revise Guidelines for Determining Brain Death

Determining brain death is a complex process that requires dozens of tests to make sure doctors come to the correct conclusion. With that goal in mind, the American Academy of Neurology has issued new guidelines -- an update of guidelines first written 15 years ago -- that call on doctors to conduct a lengthy examination, including following a step-by-step checklist of some 25 tests and criteria that must be met before a person can be considered brain dead. The goal of the guidelines is to remove some of the guess work and variability among doctors in their procedure for declaring brain death, which previous research has found to be a problem. US News

Brain Scan May Foster Communication With Vegetative Patients: Experts Say Study May Reinvigorate Right-to-Life Debate

For the brother of Terri Schiavo, Wednesday's news that a team of researchers in England were able to use a novel scanning technology to establish limited communication with a man in a persistent vegetative state was bittersweet. A low percentage of vegetative patients are more conscious than once thought. Bobby Schindler said that while the test using functional magnetic resonance imaging likely holds promise for the families of minimally conscious and persistently vegetative patients, he wishes his sister had been afforded this technology before a court ruling allowed her husband Michael Schiavo to remove her feeding tube in 2005 leading to her death. ABC News

They Really, Really Want To Kill For Organs

For years bioethicists have said removing unwanted life support isn’t killing. And they are right, since death comes from the underlying disease. But now, it is because we want more organs? This is surreal. Here is what is going on: The very crowdwho assured us that brain death was dead, are now saying it isn’t. And the reason for both arguments is the same–to increase the supply of organs. But if brain dead isn’t dead, the only ethical answer is to stop killing patients, not find new ones to terminate. Secondhand Smoke, part 2

What and when is death

The President’s Council on Bioethics has taken up this question in a recently published report entitled Controversies in the Determination of Death. At stake in the report is the moral status of those human beings who are “suspended at the threshold.” These are human beings who have suffered the worst sort of injury to the brain, but who, with technological support, retain ambiguous signs of life. The brain injury leaves them in a state of incapacitation significantly more profound than that associated with the “persistent vegetative state,” the condition associated with the cases of Karen Ann Quinlan, Nancy Cruzan, and Terri Schiavo. The name given to their injury is “brain death,” or sometimes “whole brain death.” The President’s Council suggests a more neutral term: “total brain failure.” Calling the condition by this name does not pre-judge the question of whether the patient so diagnosed is alive or dead. The New Atlantis

In the Hands of Strangers: The Fight for Gary Harvey

This is a case where a 55 year old man had a heart attack, fell down the basement stairs, and ended up severely brain damaged. It is a case where still another so-called ethics committee felt it had some sort of god-like wisdom and right to determine life or death for a stranger. It is a case where a so-called ethics committee decided, behind closed doors, that it was perfectly okay to starve and dehydrate this man — Gary Harvey — to death by termination of his Total Parenteral Nutrition feeding tube. Dakota Voice

New research may help unlock vegetative and minimally conscious patients

Seven years after doctors first defined the minimally conscious state, which is 10 times as prevalent as the more recognized vegetative state, it still lacks an international classification of diseases code from the World Health Organization, making it essentially invisible in modern health care. In 2007, an Institute of Medicine panel identified the need for a study to gather basic data like how many MCS patients there are and where they live, but the institute couldn't raise the funding. These patients are not terminal, but doctors are ill-equipped to decide not only who will recover but to advise families on what the mental life of a person in MCS is like. Reports of dramatic "awakenings" led to the discovery that neuroplasticity—structural growth in brain networks—can continue even 19 years after severe traumatic brain injury. Few living wills contain the possibility of a prolonged period in and out of awareness, and many families are tormented by how long they should wait before withdrawing care, typically done by stopping tube feeds. Slate

Brain Death: Can It Be Resuscitated?

Why is a patient with a destroyed brain considered dead rather than moribund and irreversibly comatose? The world has been grappling with this question for the past four decades with little success. The recently released white paper of the President’s Council on Bioethics is in many respects a refreshing, thoughtful, and comprehensive reexamination of this complex topic. The Hastings Center

A Day in Pro-Life History - Remembering Terri

Four years ago, March 31, 2005, Terri Schiavo died after almost two weeks without food or water. Remembering Terri Schiavo

Italian Senate Approves End-of-Life Bill That Bans Withdrawing Food and Water From Patients

The Italian Senate approved a bill Thursday to ban caregivers from suspending food and water to any patient — a move that comes after a right-to-die case divided the nation. The woman in that case, Eluana Englaro, died last month after her family cut off her food and water. She had been at the center of a legal battle since entering a vegetative state following a 1992 car accident. The new bill, if approved by the lower house of parliament, would allow people to decide in advance how they want to be treated if they become incapacitated and to state it in a living will. Currently, Italy has no law allowing a living will. Italian End-of-Life Senate Bill

Is He Dead Yet?

No matter what side of the organ donor argument you are on, when you read Zach Dunlap's story you will probably take a step back - to contemplate.

Zach's "brain dead" to life story (transcript) and Zach's Interview

Parents' Hospital Lawsuit Says Teen Was 'Killed' For Organs

The parents of an 18-year-old who suffered a brain injury in a 2007 snowboarding accident say his doctors "intentionally killed" him to harvest his organs. In the lawsuit filed this week in the U.S. District Court of Western Pennsylvania, Michael and Teresa Jacobs claim that doctors "hastened" their son Gregory Jacobs' death by delaying treatment and ultimately pulling his breathing tube, causing him to suffocate. Teen Killed for Organs?