Brain Death (eBook)

Contents 6
Preface 7
The Concept of Brain Death Did Not Evolve to Benefit Organ Transplants 8
Historical Evolution of the Brain Death Concept 8
Resuscitation and Techniques for Restoring or Substituting Heartbeat and Lung Functions 9
Historical Accounts of Brain Death 12
History of Transplantation 17
Summary and Conclusions 21
References 22
The First Organ Transplant from a Brain- Dead Donor 28
Alexandre's Personal History 29
The Ciba Symposium 30
Evolution of an Idea 36
References 36
Conceptual Approach to Human Death on Neurological Grounds 39
Introduction 39
Mechanisms of Consciousness Generation 40
Brain Oriented Standards of Death 49
The Whole Brain Standard 49
The Brainstem Death Standard 51
The Higher Brain Standard Figure 3.9 53
New Standard of Human Death 55
Conclusion 62
References 62
Clinical Diagnosis of Brain Death 78
Signs of Death 79
Signs I and II: Irreversible Loss of Respiratory and Cardiocirculatory Functions 79
Sign III: Algor Mortis 80
Sign IV: Livor Mortis 81
Sign V: Rigor Mortis 81
Sign VI: Cadaveric Spasm 82
Sign VII: Loss of Muscle Contraction 82
Sign VIII: Putrefaction 82
Sign IX: Irreversible Loss of Brain Functions 83
References 95
Ancillary Tests in Brain Death Confirmation 109
Tests to Demonstrate a Complete Cessation of Brain Circulation 109
Cerebral Angiography 111
Cerebral Intravenous Digital Subtraction Angiography 112
Intravenous Radionuclide Angiography 113
Single Photon Emission Computed Tomography 113
Transcranial Doppler Ultrasonography 114
Other Techniques to Detect Absent Brain Circulation 117
Confirmatory Tests to Demonstrate Loss of Bioelectrical Activity 118
Electroencephalogram 118
Digital EEG and Neuromonitoring 120
Multimodality Evoked Potentials and Electroretinography 122
Visual Evoked Potentials and Electroretinography 122
Brainstem Auditory Evoked Potentials 124
Short Latency Somatosensory Evoked Potentials 128
Multimodality Evoked Potentials 131
Heart Rate Variability 134
Heart Rate Variability Calculation 134
Heart Rate Variability in Brain Death and Coma 136
References 138
Brain Death in Children 165
Apnea Test 167
Brain Death Determination in the Newborn 167
Anencephalics 168
Fetal Brain Death 170
References 170
Vegetative and Minimally Conscious States and Other Disturbances of Consciousness 176
Clinical Findings in Persistent Vegetative State Patients 177
Comparison of Brain Death, Coma, Vegetative State, Minimally Conscious State, and Locked- in Syndrome 179
Brain Death 179
Coma 179
Locked-In Syndrome 179
Minimally Conscious State 179
Pathophysiological Explanation 182
Neuroimaging Techniques 185
Neurophysiological Techniques 188
Recuperation in the Persistent Vegetative State 190
Do Vegetative State Patients Suffer? 191
References 192
Brain Death and Organ Transplantation: Ethical Issues 207
Death as a Biological Notion 207
Irreversibility and Potentiality 208
Death: Event vs. Process? 209
Brain Death and Organ Transplants 209
References 210
Legal Considerations on the Determination and Certification of Human Death 215
Cuban Law for the Determination of Death 216
The Civil Code 216
Distinguishing Features of Article 26.1 of the Current Cuban Civil Code13,56,57 216
Law Within a Ministry 217
Diagnosis of Death 218
Conclusion 218
References 218