Brain Death: You're Legally Dead Despite Your Beating Heart

Andrew N. Wilner, MD

Disclosures

September 23, 2013

In This Article

Introduction

Andrew N. Wilner, MD

Eban Alexander, MD, a neurosurgeon, recently described a visit to heaven in his book Proof of Heaven. Dr. Alexander reports that he suffered from a severe case of bacterial meningitis and was in a coma. He wrote, "During my coma my brain wasn't working improperly -- it wasn't working at all."[1] Dr. Alexander would lead readers to believe that he was brain dead and experienced the afterlife, presumably the realm where heaven (and its antithesis) are located. The fact that Proof of Heaven has sold 2 million copies in 35 countries indicates that many people are interested in this topic.

But Dr. Alexander doesn't report that he was clinically brain dead by American Academy of Neurology criteria. Rather, he was in a drug-induced coma. In reality, his was not a journey into the afterlife, but rather a near-death experience or merely a vivid hallucination.

Ethical Considerations of Organ Transplant

Several thousand people are added to transplant waiting lists each month, and some of these die each day, still waiting. The ethical use of organ transplants requires donor consent, with the implicit concept that the owner will survive without the organ or has no more use for it (because he or she has died). For example, healthy living donors may offer bone marrow or 1 of their 2 kidneys or lungs. However, nonpaired vital organs, such as heart and liver, may only be donated by deceased individuals.[2] Many people carry cards to indicate their advance consent for organ donation, should the opportunity arise. This strategy facilitates organ donation because obtaining consent after death is problematic, requiring family members or other surrogates.

Donor Concerns

Some people may hesitate before consenting to act as organ donors. Potential donors of vital organs may rightly ask, "How can I be sure that I am really dead before they take my organs?"

Brain Death Definition

In 1968, an Ad Hoc Committee of Harvard Medical School defined "irreversible coma" as a "new criterion for death."[3] The authors argued that there was a need for a new definition of death because:

1. Improvements in resuscitative and supportive measures have led to increased efforts to save persons who are desperately injured. Sometimes these efforts have only partial success, so that the result is an individual whose heart continues to beat but whose brain is irreversibly damaged. The burden is great on patients who suffer permanent loss of intellect, on their families, on the hospitals, and on persons in need of hospital beds occupied by these comatose patients.

2. Obsolete criteria for the definition of death can lead to controversy in obtaining organs for transplantation.

The report describes details of the clinical examination that provide evidence for loss of brain function consistent with "brain death syndrome" or "irreversible coma." These new criteria were proposed to supplant the traditional and legal criteria that required a total cessation of vital functions, including "circulation of the blood."[3]

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