What do we really know about brain death?

“Many members of the public do not understand the distinction between brain death and neurologic states such as coma and persistent vegetative state.” Dr. Joe Vukov, in his talk, explained not only the distinction amongst these three, but also why the public has such a hard time understanding the distinction amongst those three states. To begin his talk, Dr. Vukov, explained the incorrect statements that health professionals make when speaking about these states, especially when conversing with the families of a brain-dead patient. Dr. Vukov recommended that health professionals be a bit more cautious of not only the distinction between these states, but also better communicate it to the families in the terms of how it actually is: death. Dr. Vukov, then, explained the differences amongst the three states, he first explained the state of coma which he defines as a state of unconsciousness in which a person can’t be awakened and are usually unresponsive to painful or verbal stimuli. Coma is typically irreversible. Then, Dr. Vukov explained persistent vegetative state as a “state of unconsciousness that continues for a long period of time,” however in that state, the only difference is that the patient does not require a ventilator for support as they’re able to breathe on their own. A patient in Persistent vegetative state may have some degree of awareness and might have a possibility of recovering some function. Unlike the optimism that some families receive from having a loved one in a persistent vegetative state, families of a brain-dead patient do not receive that same optimism. Brain death is defined and determined through the following criteria: “irreversible coma, absence of function of the entire brain, including the brainstem, and lack of spontaneous respiration,” if a person fits into all these categories, the person is declared to be dead. However, to determine whether the coma is actually irreversible or not, appropriate tests are performed so as not to make a wrong diagnosis.

Dr. Vukov told us a clear black and white spectrum of death by presenting us with the criteria of brain death. However, a recent article posted by Gina Kolata on “’Partly alive ‘: Scientists Revive Cells in Brains from Dead Pigs,” raises new questions as it introduces a discovery in which researchers were able to restore cellular activity in brains that were removed from slaughtered pigs. Although no electrical signaling was present as the solution that was given to the brains contained chemicals to block nervous activity, they did however see blood vessels in the pigs’ brains starting to function, and certain brain cells even regained metabolic activity which even responded to drugs. This raises a lot of controversy on the topic of brain death, as we’re starting to learn that parts of the brain may be recoverable after death. This raises not only a lot of question about brain death itself, but also of what is actually considered dead, alive, or partly alive now. Where does partly alive stand in terms of death? Although this is a new topic for scientists, health professionals, and bioethics to discuss about to determine some kind of criteria of distinguishing these three spectrums of life and death, researchers are quite optimistic with this discovery for multiple reasons. Now, not only are we able to learn about the whole mammalian brain outside the body after death, we’re able to learn more about brain injuries, cellular repair, and how drugs affect the brain, which might even help us discover what drugs can help recover the brain from such traumatic brain injuries. This discovery paves the way into many new discoveries and cures for other injuries and diseases. Dr. Farahany who speaks about this research states that a solution like the one given to the brains of the dead pigs, can possibly even help resuscitate patients in the future, which she thinks can be a possible standard medical practice. This discovery can create the biggest advancement for human life, as it can reduce the number of brain-dead patients.

References

Kolata, G. (2019, April 17). 'Partly Alive': Scientists Revive Cells in Brains From Dead Pigs. Retrieved from https://www.nytimes.com/2019/04/17/science/brain-dead-pigs.html?searchResultPosition=42

Powell, T. (n.d.). Brain Death: What Health Professionals Should Know. Retrieved from https://www.dropbox.com/sh/yrruoccwcc8fc6i/AADV3iapxtsrrO019ar7ZD3oa/(04.02.19) - Joe Vukov?dl=0&preview=Powell_Brain_Death.pdf&subfolder_nav_tracking=1