Friday, June 20, 2008

"Brain Dead" May Not Really Be Dead

The controversy over whether brain dead is really dead may have just heated up with a peer reviewed article in Spinal Cord ((2008) 46, 396-40. (I don't have a link.)

The author, a Greek physician named KG Karakatsanis, concludes that declaration of death by neurological criteria is not reliable and may not be dead. The authors' philosophical reaction with regard to organ donation is worrisome because, it seems to me, it would destroy the dead donor rule that requires vital non-paired organs to only be procured from dead bodies. Karakatsanis writes:

We consider that the interest of the organ transplantation program would be better served by 'openness and honesty'. The harvesting of vital organs for transplantation--from patients suffering from 'irreversible apneic coma' (an identical clinical condition to 'brain death1)--who had already given their informed consent for this purpose at an unsuspected time-would be socially and morally acceptable in societies which consider that the autonomy of the person justifies such a donation.
Again, we see hints that "choice" justifies everything, even potentially killing for organs. And if it is true for someone with a catastrophic brain injury, who may have decided ahead of time to donate in such a circumstance, why would it not be even more true of a person, say, who has become quadriplegic, is currently competent, believes their life is no longer worth living, and so asks to be euthanized and harvested? By the way, allowing just such scenarios have been proposed in respected bioethics journals.

This is very thin ice. If brain dead isn't really dead, then only "heart dead" patients should be used as sources of non paired vital organs. If we go the other way, not only will solemn promises made to the public about the ethics of organ donation be broken, but with the shattering of the dead donor rule it would be Katy bar the door.



At June 20, 2008 , Blogger GrannyGrump said...

Brain Death is Not Death

There needs to be informed consent, both for those who sign donor cards and those who receive transplants, that the organs in question are cut from living bodies of people who have to be strapped down and dosed with paralytic drugs in order to get the organs out, and that it is removing the organs that causes death.

This would probably go far to reduce demand. I will never consent to a transplant that requires a "brain dead" donor.

At June 20, 2008 , Blogger Lydia McGrew said...

Wesley, I'd like the PDF. We've exchanged e-mail, so you may have my address, but if not tell me here and I'll fire a note to you first. (I have yours.) Or you can get it (I think) through my blogger profile.

How recent is this article? I heard of one coming to similar conclusions (it was referenced in a different article) but thought it was from several years ago.

At June 21, 2008 , Blogger Lydia McGrew said...

I read the article. Very interesting. I wasn't able to follow all his arguments because of the medical terminology, but the one I got that I thought was particularly interesting was that what are now dismissed as spinal reflexes could very well be coming from the brain, and that this is particularly likely since they do not occur at least during the first four days or so in patients with high-spine injuries. He also appears to be saying that tests for blood flow are only about 90% reliable at best because other tests have found brain activity even when the blood flow tests said there was no blood flow. The hypothalmus argument was interesting too--namely, that if no blood was getting to and from the brain, one would expect that various functions for which the hypothalmus is necessary would break down.

I was interested that he didn't mention the issue of anesthetizing patients before organ transplant to avoid what appear to be pain responses. See here:

(That's to a BBC article.)

But there are problems with the NHBD protocol, too, given that people are being revived quite a bit later (as in a post you put up), and the NHBD protocol usually calls for waiting only five minutes at the most, sometimes three. That doesn't sound good, either.

At July 14, 2008 , Blogger K.G.Karakatsanis said...

I read Mr Wesley Smith’s comments concerning my article published recently in Spinal Cord 2008;46(6):396-401.
If Mr Smith had studied carefully my article –especially the last paragraph in the epilogue- he would not have given such a mistaken information regarding my “philosophical reaction to organ donation”; my attitude on organ donation is easily presumed from the article, especially from the last paragraph (which, unfortunately, was not presented by Mr Smith); this paragraph is the following: “However, others consider –on philosophical grounds- that they are not justified in taking their own life for any reason; nevertheless, they would agree with the donation of one of the paired vital organs or part of a single organ from healthy volunteers or of whatever organ from donors who are already irreversibly dead (according to the cardiopulmonary criterion of death) and have given their informed consent at an earlier time”. Therefore, Mr Smith, isolating one paragraph from my article, is being unfair to me and gives mistaken information to his readers –I believe unintentionally.
I understand the great problem that face all these who have accepted the term “brain death” as synonymous to biological death; in case one accepts that the “brain dead” patients are alive, the dead donor rule has to be abandoned. In this case, I think that the “cure” is “Openness and honesty”; that is: a) informing the public that “brain dead” patients are not really dead –rather, they are suffering from “irreversible apneic coma”, a condition leading, after some time, to death and b) that, according to several investigators, the concept of “brain death” was developed to permit vital organ transplantations. Should this crucial information is given to public, people could freely decide what their legislation –concerning organ transplantation- would be.
K.G.Karakatsanis, M.D., PhD.


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