When Is Someone Dead or Dead Enough?

According to some ethicists, The current medical definition of death is wrong ... and this mistake is costing lives.

The controversy swirls around organ donation, in which doctors remove organs from brain dead patients:

Most organs donated from the deceased come from people who have been diagnosed as brain dead. Organs remain viable for only about an hour or two after a person's last heartbeat. Brain dead patients are ideal candidates for organ donation, then, because they are kept on ventilators, which means their heart and lungs continue to work, ensuring that a steady flow of oxygen-rich blood keeps their organs healthy. Surgeons remove the donor's organs, then shut off the ventilator. The patient's heart eventually stops.

Yet a small but vocal minority in the medical community has always insisted that some brain dead patients may not be dead. For instance, one study documented some kind of brain activity in up to 20 percent of people declared brain dead, suggesting to some critics that doctors sometimes misdiagnose the condition. Although some neurologists contend the claim, University of Wisconsin medical ethicist Dr. Norman Fost points to research showing that many "brain dead" patients have a functioning hypothalamus, a structure at the base of the brain that governs certain bodily functions, such as blood pressure and appetite.

"We have been taking organs out of those patients by the thousands," says Fost, "and they are not brain dead."

Others point to the unsettling fact that the brain dead look alive -- their hearts beat, lungs function (albeit with the aid of a respirator), and skin retains a pink hue. Brain dead women have even given birth.

"There is nobody in the world of philosophy and bioethics who thinks brain death is a coherent concept," says Truog.

Here's an interesting article by Timothy Gower in The Boston Globe: Link - via Look At This

I'd like to see outcomes. How many of the patients who have functioning hypothalamuses have ever regained further brain function? How many of those "up to 20%"?
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Referring to yourself as a "medical ethicist" is a great way to identify yourself as an attention whore. Do they think it's more fair to leave someone in a vegetative state for decades on end, sucking money out of their family's or the government's pockets and not getting better?
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I would like to see a reference for the brain dead woman giving birth.

There is more than one misnomer in the article.

DCD procedures, as they're called in the States, are only planned when irreversible and terminal damage has been done. Most tend to come from ITU. On occasion, an intended donor's heart does not stop beating and organ retrieval does not go ahead. I have never heard of any physician doing anything to speed up the process of death - in my experience.

Non-heart-beating donor kidneys are associated with higher rates of acute rejection and delayed function.

I think it's inflammatory and incorrect to suggest that not taking organs from someone with some remaining activity in the most primitive parts of the brain, i.e. the brainstem and areas that regulate basal functions, is equal to 'saving' them. These people will not recover to a normal state, nor even consciousness.

It's an interesting and difficult ethical debate.
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Ugh. I can't believe someone's conflating the brain dead issue by referring to a person still having a functioning hypothalamus. That's not the part that has any of the person in it. It does all the automatic processes; there are no memories there, no personality... if everything but the brain stem regions are dead, that person is gone in every way but body.
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A recent story of a brain dead person coming back to life...

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Amen, Bean. I'd love to see the credentials of this "medical ethicist". My guess is that he's some sort of religious fundamentalist trying to bring back the good old days of the Terry Schiavo idiocy.

If my organs can be used to help someone else, pull the plug, even if I'm not technically all the way dead.
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"There is nobody in the world of philosophy and bioethics who thinks brain death is a coherent concept," says Truog.

well, that's a bold statement... I bet I could find (at least) some philosophy professors at the nearby university that think that's a good measure of death.
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What is so bad about death that people are willing to be kept alive by a machine for as long as possible? And what is so great about eventual death by pneumonia, sepsis, or multiple organ failure?

I've seen it plenty of times and it's not pretty.

For my part, I'm looking forward to the afterlife.
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The editing here was pure spin. The actual article was more of an examination of the different sides than an outright assertion that brain dead isn't dead enough for organ donation.
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I called my parents during the whole Terry Schiavo thing and reminded them that if I'm brain dead they should pull the plug. My mom's response was basically, "well, duh."
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I bet Zack Dunlap is glad his doctors weren't so quick with their scalpels. It's stories like those that make one question what "dead" really is. Maybe there needs to be better criteria or something. I realize that doctors want those organs while they're still "fresh", but how can they really say for sure if someone is going to recover or not? Strange things happen all the time.
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