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EDITORIAL |
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| Year : 2014 | Volume
: 32
| Issue : 2 | Page : 89-90 |
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Life after brain death: Is the body still "alive"?
ND Shashikiran
People's College of Dental Sciences, Bhopal, Madhya Pradesh, India
| Date of Web Publication | 17-Apr-2014 |
Correspondence Address:
N D Shashikiran
People's College of Dental Sciences, Bhopal, Madhya Pradesh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0970-4388.130778
How to cite this article:
Shashikiran N D. Life after brain death: Is the body still "alive"?. J Indian Soc Pedod Prev Dent 2014;32:89-90 |
Finley Boyle, a 3-year-old Hawaiian girl who suffered massive brain damage after undergoing dental procedures on multiple teeth was declared brain dead on 3 rd December 2013. "Brain death" was introduced to the world, in 1968, by a committee at Harvard Medical School. The committee reported, "responsible medical opinion is to adopt new criteria for pronouncing death to have occurred in an individual sustaining irreversible coma as a result of permanent brain damage." People on ventilators in intensive care units, their brains destroyed by trauma or disease, their hearts still going strong, may have been breathing, taking in nourishment, excreting waste, and healing from infection, but, at least in the opinion of doctors, they were dead - "heart-beating cadavers." Death was legally redefined, in large part, to facilitate organ donation. Among the challenges that advocated the new definition of death faced was explaining to the public why this redefinition was not simply a conceptual gerrymander. The rationale provided was that the brain-dead person was dead because the brain was the maestro that conducted the body's various instruments, and without it, the body no longer exists as an integrated whole. Indeed, the committee concluded. Brain death had always been the true death; we just didn't know it.
The hard-won consensus about brain death is more fragile than anyone might have thought. The discussion of brain death dates back to the 1950s in France with six patients who were kept "alive" for between 2 and 26 days without blood flow to the brain. This generated the idea that "perhaps there's a second way to die, because these patients will eventually die," (previously, a person was considered dead only when their heartbeat and breathing stopped.)
A person is considered brain-dead when he or she no longer has any neurological activity in the brain or brain stems - meaning no electrical impulses are being sent between brain cells. Brain death is used as an indicator of legal death in many jurisdictions, but it is defined inconsistently. Various parts of the brain may keep living when others die, and the term "brain death" has been used to refer to various combinations. For example, although a major medical dictionary says that "brain death" is synonymous with "cerebral death", the US National Library of Medicine Medical Subject Headings system defines brain death as including the brainstem. The distinctions can be important because, for example, in someone with a dead cerebrum but a living brainstem, the heartbeat and ventilation can continue unaided, whereas, in whole-brain death, only life-support equipment would keep those functions going.
As if the end-of-life dilemma it presented weren't complicated enough, the paradoxes of the living corpse seem to be just as bewildering - or at least as open to interpretation - to the hospital. "There are no ethical issues in the care of someone who is brain-dead, because the patient is now a corpse," but brain death is not quite as certain as one might like. A doctor can't always determine whether the brain is truly dead. The diagnosis is made the old-fashioned way: By careful observation. A doctor checks to see whether the eyes are responsive to light or touch; pricks the nail beds to discern whether the pain registers; tests muscle reflexes; determines whether the build-up of carbon dioxide triggers spontaneous breathing if the ventilator is shut off; and may use an electroencephalograph to detect electrical activity in the brain. (However, even a dead brain may produce some voltage.) If all the findings are negative, then the declaration is made. Even then, the doctor can be wrong. Patients declared dead have begun to breathe on their own, after the machines were withdrawn; organ donors have shown signs of life, even as their organs were being removed; and in at least one case, the harvest was aborted and the patient eventually went home, neurologically impaired but decidedly alive. And there are cases, well-known among transplant doctors and ethicists, in which people have taken home "dead bodies" that, have gone on to live for long periods.
Our sense that a body is not dead until it is still and cold may be uninformed and unscientific, but so is our sense that the sun moves across the sky from east to west, and most of us live our lives as if this were the case. The concept of brain death has its uses; organ transplants save many lives. However it has its limits, too, as these cases show, chief among them the fact that it is a concept dreamed up by humans in their quest to overcome suffering, one that can have difficulty standing up to the power of love and the implacable mysteries of death. It is our duty as pediatric dentist to be well-versed with the management of any emergency case because even a simple dental procedure can result in brain death.
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Shashikiran N.D.
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