Talk:Brain death

Another question about removed text

24.0.133.234, why did you make edit? What do you think is false about this statement: "If a brain-dead individual is not an organ donor or consent is not given by the legal next of kin, ventilator and drug support is discontinued, circulation stops, and the organs cease to function."? Your edit summary said something about the US but the statement is a general, logical, medical conclusion to what happens if someone isn't a donor. What is your contrary evidence that this statement is not true? Ca2james (talk) 02:24, 8 March 2014 (UTC)

I took the statement out rather than add a whole lot of info that would qualify that statement. In some countries, and states-and/or cases, such as the Jahi Mcmath case, brain dead people are cared-for until the heart permanently stops beating, or a decision by the appointed decision-maker to discontinue treatment(s), or refuse further resusitation-(DNR)...and other options that are available and practiced worldwide.

And again, if we are specifically referring to organ donors or potential organ donors there-does it belong in a brain death article? And if it does, the statement STILL needed to specify that and the condition, or circumstances.

It COULD be a good point in the article, but it just left-out other options making it look like that is/was the case in all instances, everywhere. "What happens after brain death when mechanical and medical support continues" could maybe be a good sub-section, with the options and variations expanded if that is not already in another article which could otherwise be linked?24.0.133.234 (talk) 16:18, 8 March 2014 (UTC)

Organ donation restored

Seems like it might be a bit undue as presented, but it definitely belongs judging by the sources and content, both here and at Organ donation.

The section here could be improved to better summarize the issues, given that the details should be in (and are in) Organ donation.

Is the brief sentence in the lede a good summary? --Ronz (talk) 18:25, 11 March 2014 (UTC)

I think that the use of the term brain death has been evolving. The term has a significant relation to organ donation, but also used as a diagnoses. Sometimes (more recently and I don't know if it is being used correctly in these cases, depending on who is using the term and what they are referring-to) it is used to indicate permanent loss of consciousness with no hope of recovery which results in legal death-even-if organ donation is not involved. Legal death is not required to terminate life support but it is always required to recover organs.(edit to add)24.0.133.234 (talk) 14:33, 12 March 2014 (UTC) from brain dead donors.24.0.133.234 (talk) 14:33, 12 March 2014 (UTC)

There are definitions of areas of brain death which are referred-to with terms like ischemia, or even tumors,necrosis--- such as stroke and other brain-damaging conditions that are not fatal, or not permanent, and recoverable. Any dead part of a brain stays dead from the way that I understand it, but recovery from brain-damage from dead parts of the brain is common. I may try to expand on that in the article with references. I'm not sure if that would be a good idea or how to apply it to the article though? People with these conditions, technically may have some brain death, but they would not be considered legally dead.

The diagnoses of whole brain death or whole brain death including brain-stem Uniform Determination of Death Act(latter means that mechanical ventilation would be needed to maintain respiration), requires clinical observations and in legal deathtype-brain death, requires scientific tests to verify, based-on local policy. Diagnosing irreversible BD, can also prevent futile treatment or assist in a differential diagnoses where brain death is suspected.24.0.133.234 (talk) 11:34, 12 March 2014 (UTC)

To answer opinion of organ donation in the lede, it looks OK to me, but maybe add internal link to legal death?

The opening statement "due to total necrosis[verification needed] of the cerebral neurons following loss of brain oxygenation[verification needed]."---would be more correct if it said, "can be due to..." I'm thinking of crushing accidents/physical trauma24.0.133.234 (talk) 12:01, 12 March 2014 (UTC)

Do you have reliable sources that describe how the term "brain death" has been evolving? The current literature seems to describe brain death fairly rigorously and specifically, and while "irreversible" is used in the definition, it is not used in the term itself.

The organ donation section is a bit of a mess and could use a rewrite; I'm thinking that it would be better to get this section done first before figuring out how to summarize it in the lead. I know I said above that this section should summarize the main article but I think I was wrong on that. I think it would be better to restrict the discuss in that section to organ donation as it relates to brain death.

I think it's fair to start with something like, "Although organ donation does occur after cardiac death or from living donors, a significant proportion of organ donation occurs in the setting of brain death," to establish relevance to the topic of brain death. After that, a brief summary of the history of brain death as it relates to organ donation might be appropriate, followed by the general medical procedure for donating organs. There are articles out there saying that determining brain death (particularly the second test) may have a detrimental impact on the quality of donated organs; perhaps that could be included. I don't think that the organ donation section in the brain death article needs a discussion on how people decide to be brain donors in different countries, opt-in/opt-out systems, or the black market. Thoughts? Ca2james (talk) 17:48, 12 March 2014 (UTC)

Going backwards w/your comments Ca2james, completely agree that further discussion about organ donation should be left out of this article.

(this--->)"second test) may have a detrimental impact on the quality of donated organs; perhaps that could be included."...that is pretty interesting and if this brain death article has a section or paragraph that focuses on the tests used in diagnosing BD, (unless we just defer that to legal BD or somewhere else, but since this article does have an ICD9 box?? I think that we can lean on that pretty heavily), so if the article discusses these medical tests, that could fit and I think it should be included?

.............medical procedure for organ donation/recovery, I think leaving that out or another internal link would be even better....

and finally ""Although organ donation does occur after cardiac death or from living donors, a significant proportion of organ donation occurs in the setting of brain death," to establish relevance to the topic of brain death. After that, a brief summary of the history of brain death as it relates to organ donation might be appropriate,--" ..extremely brief remark about BD and organ donation, again with internal link to maybe a WP article about the Harvard opinion of 1968

.......And finally organ recovery and transplant after cardiac death? WAY-too complicated. (they even have a category of organ and it is called an ECD Expanded Criteria Donor,and we don't even want to get into "controlled cardiac death-do we?-its organ donor specific) as-opposed to brain dead donor who transplant orgs refer-to as "cadaver donors"-(those being the legally brain dead who are mechanically ventilated).

BUT, I think that --->"a significant proportion of organ donation occurs in the setting of brain death" is perfect, and might be ALL that is needed in this article along-with brief mention to transplants/brain death historical relation?

I don't know if the "evolution" of BD is a good idea although maybe something about how the term is used in different contexts and different fields again-sticking to the ICD-9 box might be better and instead of changing or evolution of the term and/or some history pre-Harvard, the Ad-Hoc Harvard committee http://www.ascensionhealth.org/index.php?option=com_content&view=article&id=153&Itemid=172....and then there were some other landmarks/changes like more tests needed and ruling-out hypothermia etc. 24.0.133.234 (talk) 23:06, 12 March 2014 (UTC)

24.0.133.234 (talk) 23:32, 12 March 2014 (UTC)

I think you're right that we don't want to introduce things related to either cardiac death or that (interesting but irrelevant) paper on brain death tests and organ quality in this section because it complicates the article. However, I don't understand what you're asking for in your last paragraph; can you give me a sample of what you're thinking would be a good addition to the organ donation section? Thanks. Ca2james (talk) 17:40, 16 March 2014 (UTC)

OK-I just looked at the organ section, and I would probably just eliminate the part about people in "some places" as being automatically considered as organ donors since brain death only factors-in for the people diagnosed with brain death. That should be on the organ donation article though.

I'm also wondering if the part that I added about DNR and advance directives will stay current or if it still is due to the fact that in some places, a declaration of legal death/brain death should override that? -I don't know if a DNR would cover someone who has already been declared legally dead?--although I have seen references to advance directives such as this confounding efforts to donate organs.

I also really like "a significant proportion of organ donation occurs in the setting of brain death"----but leaving out other quantifiers since references tend to waffle about "preferred"-donor and extracting the data about types of organ donors is an exercise in OR anyways. — Preceding unsigned comment added by 24.0.133.234 (talk) 20:56, 17 March 2014 (UTC)

I agree with those changes and I agree that the DNR stuff doesn't belong on this article. Do you want to make the changes? Ca2james (talk) 00:41, 18 March 2014 (UTC)

Not relatable to actual death?

Is there anyone credible who believes that absolute brain death isn't synonymous with death? There have been people who turned around from this condition, as is mentioned in the article, but I think the very notion is discouraged in the public. Such views are linked with extremism, families desperately hoping against hope, and links to the anti-euthanasia movement. But is there anyone with theories about people returning from 'brain dead' state, or otherwise innovative or explanative thoughts on the problems associated with this concept? --IronMaidenRocks (talk) 12:54, 1 May 2014 (UTC)

Sorry to answer this so late but what i think you are referring-to would be considered a misdiagnoses. At this point, "brain death" is considered to be a final-permanent, irreversible loss of consciousness along-with physical signs and test-results to confirm. People's other vital organs "return" from brain death through transplantation I guess you could say, but although there is debate about misdiagnoses and tests used to determine brain death, (because any repairable or recoverable condition labeled as brain death would be a misdiagnoses)--an irreversible loss of consciousness is what it is.24.0.133.234 (talk) 16:23, 5 September 2014 (UTC)

Bibliography:

Wijdicks, Eelco F.M. "Evidence-based Guideline Update: Determining Brain Death in Adults." Evidence-based Guideline Update: Determining Brain Death in Adults. American Academy of Neurology, 8 June 2010. Web. 22 Feb. 2016.

Busser, Jonathan. "Ectopic Cell Cycle Proteins Predict the Sites of Neuronal Cell Death in Alzheimer's Disease Brain." Ectopic Cell Cycle Proteins Predict the Sites of Neuronal Cell Death in Alzheimer's Disease Brain. The Journal of Neuroscience, 15 Apr. 1998. Web. 22 Feb. 2016.

Laureys, Steven. "THE NEUROLOGY OF CONSCIOUSNESS." Cognitive Neuroscience and Neuropathology. Elsevier, 2009. Web. 22 Feb. 2016.

Xue, Mengzhou. "Intracortical Hemorrhage Injury in Rats." Intracortical Hemorrhage Injury in Rats. Stroke, July 2000. Web. 22 Feb. 2016.

Erin, Charles A. "An Ethical Market in Human Organs." An Ethical Market in Human Organs. JME, 17 Mar. 2003. Web. 23 Feb. 2016.

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Legality

Now that the Jahi McMath case is back in the news, I think a mention of the New Jersey Declaration of Death Act (https://muse.jhu.edu/article/245624) is useful. However I don't know how to present it in context of other states' viewpoints, so someone more versed in these topics should add it in. Wqwt (talk) 19:19, 29 June 2018 (UTC)