Brain Death, Research Paper Example

History

Ganapathi (1959) describes the history of death to have first been brought up by Mollart and Goulon who called it coma depasse which means a state beyond coma. Harvard Medical School had a committee back in 1968 called the Ad Hoc which stated that the meaning of brain death is a coma that is irreversible which makes the patient to be unreceptive and fail to respond. The patient is also known to have no reflexes and the absence of respiratory effort that is meant to be spontaneous. Due to this, they came up with a conclusion that this condition could also be termed as death.

It was later suggested by Mohandas and Chou that brain death occurred for patients who had irreparable change in the tissues and brain stream damage that was irreversible which lead to the introduction of a diagnosis that is purely clinical and essential concepts of etiological conditions. In 1976, the Conference of Royal Medical Colleges issued their first memorandum which explained that brain death is constituted by a permanent failure of the brainstem’s functionality and it should be diagnosed as brain damage that is structural after analyzing conditions that might cause or contribute to having a coma.

Three years later, another memorandum was issued and this time brainstem death was seen to be equivalent to actual death. They therefore concluded that once the confirmation of the brainstem was made, the next thing would only be to declare death. Finland is said to be the first country that adopted brain death as a definition of death legally.

Definition

The term brain death can therefore be defined as a state of unconsciousness that is irreversible which causes malfunction of the brain. The malfunction is said to be caused by the premature death of cells and living tissue of a cell in the nervous system whose function is to process and transmit information. All this causes loss of concentration of oxygen and flow of blood.

The brain stem is the main affected part in the whole process of brain death. Cohen (n.d.) used the following diagram of the brain stem to illustrate its major parts:

The Midbrain

It is the brain’s smallest region whose function is to act as a relay station for information that is audio or visual. The most common functions of the midbrain are mainly eye and body movement. The midbrain is home to the cranial Nerve III which is also known as the ocumolotor nerve. It originates just below the cerebral aqueduct from the midbrain and is responsible for pupillary function and eye movement. The functions above occur as a result of the supply of motor efferents to the medical rectus, inferior rectus, superior rectus and inferior oblique muscles not forgetting the autonomic fibers through the ciliary ganglion to the body and the iris.

The Pons

The Pons is a part of the brainstem that is above the medulla oblongata which is sometimes referred to as a knob in the brain stem. The function of the Pons is to regulate relaxation. The Pons is also associated with the sense of higher purpose and it contains cranial Nerves IV, V and VI which conjugate eye movement and corneal reflex.

Medulla

The medulla, also known as the medulla oblongata, is part of the brain stem located in the lower half. Medulla has the cranial Nerves IX, X which have the pharyngeal (Gag) reflex and tracheal (Cough) reflex respiration. The medulla is responsible for functions like heart rate, breathing, swallowing, urination and blood pressure which are commonly known as the autonomic functions. It contains the centers responsible for respiratory, cardiac and vomiting and vasomotor. The medulla also acts as a link between the brain and the spinal cord because it relays nerve signals between them.

Causes

Brain death has been reported to have been caused by different things. Some of the most common causes include: penetration of drugs and ventilators into the body functions like the cardiopulmonary. It could also be caused by any ailment or injury that would make the brain to swell. Viral infections of the brain like encephalitis or abnormalities like a brain tumor can also result to brain death. In children, the most common causes of brain death are reported to be brain tumor, stroke, head injury that is traumatic and the shaken baby syndrome. Generally, brain death is said to occur when the brain stops getting supply of oxygen and blood which is commonly caused by blood clots, heart attack or even stroke.

Signs and symptoms   

The above statements explain that when the entire brain system and cerebrum has lost function, it results to a condition known as brain death. The common signs have been the loss of brain stem reflexes, loss of spontaneous respiration and coma. A coma is defined as a state where the body does not respond to noxious stimuli while the absence of brain stem reflexes is indicated by pupillary reflex, eye movements, facial sensation and motor response, pharyngeal reflex and tracheal or cough reflex. Pupillary reflex causes the pupils to be dilated such that they do not respond to bright light.

However, brain death has been distinguished from a coma because a person who is in a coma is still considered to be alive unlike in the case of brain death where the patient under life support is declared dead after being critically sick. The patient could also show no reaction to pain or no gaggling when the back of the throat is touched and the eyes do not respond to ice water poured into the ear, movements of the head or a touch on the eye surface. Incase the patient is in a ventilator, he would not breathe if it’s switched off and if put under an electroencephalogram test, the brain would show no activity. Other signs of brain damage that are either metabolic or structural should be examined for the physician to diagnose brain death.

Diagnosis

Maiese (2008) comes up with a list of nine items that should be examined before coming up with a conclusion that the patient is suffering from brain death. These items are:

1. Identifying the patient’s next of kin or any other person who is closest to the patient and telling them about the condition.
2. The physician also needs to identify the cause of coma and have a sufficient reason as to why the loss of all brain function is irreversible.
3. Ensure the exclusion of hypothermia (less than 32 degrees C), CNS depressant drugs and hypotension (MAP < 55 mm Hg). There should be no neuromuscular blockers contributing to the findings of the neurologic.
4. Incase there are any movements, they should be considered as a result of function of the spinal cord.
5. Test the absence of the pharyngeal reflexes, cough reflex or both.
6. Absence of the corneal and the papillary light responses.
7. He or she should also ensure that there are no caloric responses following ice water that is siphoned against the tympanic membrane.
8. Conduct an apnea test to confirm that there are no respiratory movements.
9. Establish either of the following criteria:-

• Items two to eight have been confirmed by two examinations separated by at least 6 h.
• The above mentioned items have been confirmed and an EEG shows electro cortical silence and a second examination at least 2h after the first confirms items two to eight.
• Items two to eight have been confirmed and the brain scanning does not show any intracranial flow of blood and a second examination at least 2h after the first confirms items two to eight.
• Incase items two to eight are not determinable because the condition or the injury hinders evaluation, then the following should apply:-
• Confirm only the assessable items.
• The brain scanning does not show any intracranial flow of blood.
• A second examination 6 h after the first confirms all the items that are assessable.

If a patient meets the above criteria, it is reported that their chance of recovery is minimal. Actually they do not recover and that is why all the treatments are terminated. When these supports are stopped, there are effects that are observed like stiff legs, arching of the back, the ‘Lazarus sign’ and pain while turning the neck. These effects are also called spinal reflexes.

According to the above findings, brain death is seen that a disease that does not give the patient a second chance or even the slightest of chances. This has been happening since 1971 when Finland officially decided to describe brain death as the true definition of legal death. All Experts (n.d).  It is important to determine on whether the condition is irreversible when diagnosing and after a series of tests as described above, the patient is declared to have brain death. In the nine items discussed above, there is need to contact the next of kin and one of the reasons could be so that they can negotiate on whether the patient can donate either of his organs to another person. If the family agrees to the request then the patient continues being under the ventilator support until the removal of the organ that is meant to be done surgically. All this brings a new dimension to look at brain death. A dimension that is positive in that, a brain death patient can save a life. Under normal circumstances, the patient in need of the organ donation would wait for a longer time hence the advantage of brain death.

Some problems that arise in the whole process of brain death are; first, the traditional way of declaring somebody’s death which is when the heart itself and other functions in the body stop, secondly, the religious opinions that have been against the whole brain death concept and lastly, the process of getting the permission to transfer an organ from that patient to another. All these problems could be solved if people were empowered more on brain death so that they can agree to make the best out of a bad condition like brain death.

Prevention of Brain Death     

If brain death is that unfair, can it be prevented? Some of the major causes of brain death are diseases affecting the flow of blood which are stokes and heart attacks. They are also known as cardiovascular diseases which can be prevented by frequent exercise, eating a healthy diet meaning that the meals are balanced and avoiding bad habits like consuming alcohol and smoking. The NHS(2009) explains the ideal diet should be one with high fibre which includes plenty of fruits and vegetables and whole grains. The diet should also have low quantities of fat and salt. Too much salt can result in increase of the blood pressure. The recommended exercise should last for thirty minutes for at least five times every week. The exercise should be vigorous enough to cause the heart to beat faster and result to a feeling of being out of breath. The NHS also provides help to people who would want to quit smoking and advices people to reduce the level of alcohol intake. Simple precautions can also be taken to avoid accidents that may cause head injuries and all this might help in brain death prevention.

Works Cited

AllExperts (n.d). Brain death.  Retrieved on November 15, 2009 from http://en.allexperts.com/../brain_death.htm

Cohen J.S. M.D(n.d.). Anatomy and Physiology. Albert Einstein College of Medicine. Retrieved on November 15, 2009 from http://hods.org/../Dr.Cohen.ppt

Ganapathi K. (1959). History of Brain Death. Retrieved on November 15, 2009 from http://www.thamburaj.com/brain_death.htm

Maiese K. January 2008. Brain Death: Coma and Impaired Consciousness: The Merck Manual. Retrieved on November 15, 2009 from http://www.merck.com/../ch212d.html

NHS. 11^TH May 2009. Brain- death- Prevention. Retrieved on November 27, 2009 from http://www.nhs.uk/../Prevention.aspx