Talk:Brain death

February 2003

Right now, this article has a tautology: "permanent" cessation of EEG activity is not reversible: well, that's true by definition.

Question: can brain electrical activity ever cease reversibly? What about deep anaesthesia, or hypothermia? The Anome

See the ECT article for one possible answer: does anyone have a cite for this? — Preceding unsigned comment added by 217.158.106.57 (talk) 12:48, 27 March 2003

Propofol brings about a dose-dependent diminution of cerebral blood flow, decreases global cerebral metabolic rate, and is potent enough to create a flat electroencephalogram in high doses. This state is rapidly reversible with no neurologic change thereafter.

"Brain death" cannot be diagnosed (by EEG) in the presence of such EEG-dampening drugs. - Nunh-huh 19:19, 31 Mar 2004 (UTC)

irreversibility of brain death

I revised the page fairly extensively, no offense intended. I am a practicing transplant surgeon and know quite a lot about the topic. The key point I would like to make is that brain dead individuals not only have lack of brain function, they have actual necrosis (death) of all brain tissue. Thus, profoundly hypothermic people can have flat EEGs but are not brain dead, at least as clinicians use the term. Assessing cerebral blood flow with radionuclide scanning (or, historically, arteriography) is extremely useful and eliminates any uncertainty about whether recovery is possible.

Another important point is that anyone with a neurologic injury severe enough to have any question of being brain dead has a negligible chance of meaningful recovery, even if they still have some respirations or other brain stem function. — Preceding unsigned comment added by 216.202.124.223 (talk) 19:16, 31 March 2004

Necrosis, now that's irreversible. Should we emphasize that as the "true" definition of brain death, with the various types of tests as a way of detecting the absence of necrosis? (ie "brain life") -- The Anome 06:10, 1 Apr 2004 (UTC)

While it is true that flat EEG's can occur in situations where the individual is not "brain dead", it is not correct to say that brain dead individuals have necrosis of all brain tissue. For one thing, brain death can often be determined within 24 hours of whatever event caused the brain death, and that is too soon for necrosis of the entire brain to have ocurred. The important thing to remember is that brain death criteria are present to determine both the complete and irreversible loss of entire brain function. Things like hypothermia and drug intoxication may cause loss of entire brain function for example, but the loss of brain function in these instances is potentially reversible so is not equivalent to brain death. Necrosis has never been a criterion for determining brain death. — Preceding unsigned comment added by Drsyme (talk • contribs) 21:42, 6 December 2005

It is incorrect that brain death indicates true death. Zach Dunlap was found brain dead, even according to a PET scan, yet recovered successfully, without lasting impairment more severe than memory loss. [1] —Preceding unsigned comment added by 68.183.229.168 (talk) 04:01, 25 March 2008 (UTC)

I think the Zach Dunlap story is incorrect, or at the very least unsubstantiated. All references to it seem to draw from the same feelgood newspaper story (light on medical detail). It is not unlikely that a doctor or, more likely, a journalist made a mistake, so it is weak evidence against brain death being true death. I suggest that the reference is removed until/if a report appears in a peer reviewed form (if he really recovered from brain death there is bound to be a case report soon!) Anders Sandberg (talk) 03:00, 26 March 2008 (UTC)

Possibly, but the father specifically remembers seeing a PET scan that showed no blood flow. According to Professor Bruce Brew, head of the Department of Neurology at St. Vincent's Hospital in Sydney, "It can be difficult to diagnose brain death. There is no absolute diagnostic tests. [sic] ... perhaps one in several hundred thousand [are mispronounced dead]. If not even rarer. By and large when people are pronounced brain dead, they unfortunately, are." [2] —Preceding unsigned comment added by 68.183.229.168 (talk) 18:47, 26 March 2008 (UTC)

Confusing Term

Another ambiguity is the use of the term "brain dead individual." If someone is brain dead they are legally dead. Once a person dies they are then a corpse and no longer an individual. This is not a trivial matter as the entire concept of brain death does not at all address the issue of what it means to be alive or dead, but is just a list of criterion to determine irreversible loss of entire brain function. It is clear to me that society has not accepted the concept of brain death as equivalent to dead because of the use of phrases such as this one.

This article needs a complete rewrite. — Preceding unsigned comment added by Drsyme (talk • contribs) 21:48, 6 December 2005

One can have an individual chair, or an individual shirt. The term seems fine for reffering to living or dead or non-animate things. HighInBC 06:36, 2 March 2006 (UTC)

Adjective or noun...? 67.183.243.198 (talk) 07:07, 31 July 2009 (UTC)

Can somebody explain this to me?

My little cousin was involved in a serious motorbike crash and was rushed to the hospital straight after the acccident. They saved his life although he has lost his eyesight and sense of smell. He was concious and abled to communicate with us by kicking his legs. We were told that his chance of surviving was good as he was only young. He was 18 at the time. Sadly, 11 days after the accident, he was pronouned brain dead. The doctors kept him breathing and his heart beat for another day so family members from abroad could come and see him for the last time. We all watched his heart beat dropped to zero by his bedside.

I am so confused and curious... my understanding was that his brain was functioning when he was at hospital, what has changed? What has made his brain decided to stop working? — Preceding unsigned comment added by 219.79.23.105 (talk) 12:42, 20 April 2006

-A reply- Without knowing the exact circumstances of the case it is difficult to be specific, however, brain death (or brain stem death) can be caused by a whole variety of things, including trauma, bleeding into the brain or brainstem, infection or lack of oxygen/blood supply to the brain or brainstem. I appreciate that he was conscious and communicative for some days before his death, but some of the above factors can cause brain death even weeks after the original accident. If you really want to find out more I suggest you speak to the doctor(s) caring for your cousin, they are usually very approachable and understanding. I am sorry for your loss.Mmoneypenny 21:09, 21 September 2006 (UTC)

-reply- You mention that "the doctors kept him breathing". Does this mean the doctors put your brother on a life support system? I am imagining that the doctors "pulled the plug" in this scenario. Can you please clarify that statement? — Preceding unsigned comment added by 68.193.139.207 (talk) 10:16, 25 July 2007

Other thoughts

In earlier times cessation of respiration and heartbeat used to tell dead or not and a common man could determine that too. Now with science all of this support the various definitions of death make it almost impossible to conclude whether the LIFE is there or not. — Preceding unsigned comment added by 210.7.132.72 (talk) 07:00, 29 August 2006

It's because there is no such thing as "life". There is only a collection of parts that fail. Defining death is a matter of picking which failed parts, typically the heart or the brain, justify giving up and letting everything else fail. 76.169.201.183 21:53, 14 January 2007 (UTC)

A.K.A. you can keep cells alive while certain parts of the body are dead, it's the sum of the whole that makes "conscious life" possible. However without the brain this isn't possible while the body can still be kept alive by machines performing the tasks the brain normally does, the individual is no longer the person they were when they were consciously alive. They're technically alive, although their brain is dead, this is the subject of debate on whether or not people should be kept alive or not because the recovery of brain cells and such is very poorly understood as it is a very long and complex process. The irreversibility factor is difficult to assess but severely extensive damage is usually justification enough. Just some thoughts... 70.162.43.130 06:58, 20 March 2007 (UTC)

Springclean

Wow, yeah we need a springclean here. Now if only I can find some time... I'll come back end of December and see if I can't lend a hand.Mmoneypenny 21:36, 21 September 2006 (UTC)

Just some thoughts post a long day in ICU!

This paragraph could be confusing to the lay-person: "Note that brain electrical activity can stop completely, or apparently completely (a "flat EEG") for some time in deep anaesthesia or during cardiac arrest before being restored. Brain death refers only to the permanent cessation of electrical activity. Numerous people who have experienced such "flat line" experiences have reported near-death experiences, the nature of which is controversial."

The typical use of "flat-line" refers to the ECG or the lectrical activity of the heart not the brain (EEG). In the vast majority of anaesthetic cases one monitors the heart and not the brain.

Also, in the ICU I work in the diagnosis frequently goes to a 4 vessel cerebral angiogram to make fully sure that there is an absense of flow. This is the "gold standard" of brain death. Frequently a person which such massive injuries as to cause brain death will have multiple cranial nerve palsies which makes cranial nerve testing unreliable.

One final thought - I think it should be made more obvious that pronouncing a patient "brain dead" is only required to allow for legal organ donation. If donation is not an option then life-support can be withdrawn without confirming brain death if the hope of any meaningful recovery is lost.

Sorry I have no idea how to edit this myself! 220.245.182.82 11:45, 7 October 2006 (UTC)Jamie

May 2008

Could the next competent medic (preferably British or with an understanding of the British criteria) to check this page please have a look at the Brain Stem Death page too. At the moment, half of it still reads like a rant from the "cardiovascular death only" lobby. 11:02, 4 May 2008 (UTC) —Preceding unsigned comment added by Tharyps (talk • contribs)

Artificial brain

Critics of the notion of brain death have sometimes argued that it could be invalidated by the futuristic existence of artificial brains, given that death in its broadest definition involves the entire body and that it happens on the cellular level, and not on any peculiar mnemonic level. Hence, if your brain unexpectedly dies, it might be replaced by one of these organic computer brains that would maintain your previous state of psychological consciousness, as one would store information on a computer disk. ADM (talk) 07:07, 25 August 2009 (UTC)

NPOV

This article needs to include criticism of the "brain death" criteria and discussion of alternative criteria for death. One prominent author here is Dr. Alan Shewmon. Also, in the religious section, I'm reading about "the lord Buddha" and just imagining the outcry if someone wrote "the lord Jesus Christ" in a Wikipedia article, so I've removed "lord" and cleaned up those sentences a bit. JKeck (talk) 01:51, 11 July 2013 (UTC)

Spelling of "brain dead": with or without hyphen

This page currently uses both "brain dead" and "brain-dead". Which is more correct, and if neither, can we standardize. Zargulon (talk) 16:16, 6 December 2013 (UTC)

Neither is incorrect, but we can standardize on the hyphenated style (brain-dead) for the reasons that are explained at English compound > Hyphenated compound modifiers regarding permanent compounds versus temporary compounds, because both AHD4 and M-W Collegiate online enter both hyphenated brain-dead (adj) and open compound brain death (noun). I'll go edit to suit. Done. Quercus solaris (talk) 20:58, 6 January 2014 (UTC)

January 2014

Wikipedia cited: In spite of Wikipedia's willingness to deny itself as credible.
Wikipedi was used as a resource to define 'Brain Death' or 'Brain-Dead'
to competent medical and civil authorities.
'Brain Death' or being 'Brain-Dead' is specifically:
Necrotic tissue or dead tissue within the brain.
Tissue which cannot support life.
The lack of detectable brain electrical activity did not support Brain Death alone. — Preceding unsigned comment added by 108.89.36.16 (talk) 19:16, 6 January 2014 (UTC)

The current version of the lede very concisely makes it very clear that the operational definitions of the term vary depending on who defines it. Therefore, it really doesn't matter who reads this article (including "competent medical and civil authorities"), because this article cannot tell them to favor one operational definition over another, and the article explicitly explains that fact to them up front. It can mention various specific references' operational definitions (and it does), but it can't pick one as "the winner" (and it doesn't try to). Anyone whose reading comprehension level is so low that they could look at this article and fail to understand those facts can't really be helped by anything short of intensive remedial education. Quercus solaris (talk) 20:18, 6 January 2014 (UTC)

Is necrosis necessarily a condition for brain-death? I think it confuses the lede. Is necrosis always found upon autopsy of brain-dead patients? I don't believe that it would be.24.0.133.234 (talk) 00:13, 4 March 2014 (UTC)

Lack of oxygen leads to cell death which is necrosis, a medical term with a specific definition. If all brain cells (aka neurons) stop receiving oxygen, all of them will undergo necrosis. The initial changes to the cells will be small and not necessarily seen on autopsy, but that doesn't mean that necrosis hasn't occurred. Ca2james (talk) 15:57, 4 March 2014 (UTC)

Sorry Ca2james, but I am really not comfortable with "necrosis" -(and yes i know what that is lol), being given in this article/lede as a criteria for brain death. The definition of legal brain death criteria and tests for that have been established, and necrosis does not factor-in in most cases from the way that I understand it.

Since the (incorrect imo) word has remained in the article for some time now, I am hesitant to change it but I will be looking-for references that could support rm of "necrosis".24.0.133.234 (talk) 16:54, 6 March 2014 (UTC)

The term is medically correct. What are your policy objections and what is your suggested re-wording? Ca2james (talk) 17:07, 6 March 2014 (UTC)

Religious views

The section on religious views is a discussion on religious views with respect to organ donation, not brain death. I think this section needs to be re-worked to add religious views on brain death and remove the organ transplantation discussion but I don't really have the knowledge to make this change. Also, I'm a newbie and while I know I should be bold in my edits, I'm reluctant to make such a big change on a section that's been around this long. Ca2james (talk) 17:42, 20 February 2014 (UTC)

Since no one has commented, I moved the religious views subsection to the organ donation section and reworked the first sentence. This maintains the text but stops it from being WP:COATRACK in the Legal history section. The entire organ donation section may still be coatrack text but now it can all be considered together. Ca2james (talk) 15:51, 4 March 2014 (UTC)

Question about removed text

24.0.133.234, why did you remove the sentence, "Most organ donation for organ transplantation is done in the setting of brain death."? Ca2james (talk) 02:53, 6 March 2014 (UTC)

In the same vein, 24.0.133.234, re your edit note: "this is true. Please stop deleting everything that is not cited-just tag it if you must." - No, I will not just take your word that something is "true" if a) there is no citation or b) your edit is not borne out by the cited reference(s). Stop making unsourced claims. This is an encyclopedia, not your personal soapbox. Funcrunch (talk) 06:13, 6 March 2014 (UTC)

Ca2james I wholly deleted that statement because I don't believe that it is correct. The only other place that I have seen that statement (worded like that) was in a ref. to an About.com article and that article had no reference. LIVING people for instance donate organs for organ transplantation (kidneys mainly?), all day every day. I did not want to CHANGE that sentence, but we just don't have the references and statistics to back it up and are we talking USA-or globally? In Japan, I think I saw figures as high as 90-something per cent of organ transplant is from a living or clinically dead donors--(from how I recall don't consider that as fact).

Trying to FIND the correct statistics is a little tricky because in the US for instance, when they say, "cadaver donor"-they mean brain-dead/someone on a ventilator. So they show statistics between brain dead donors and living donors, when talking about kidney transplants for instance, but there is basically NO SUCH THING as a heart transplant from a living donor, permanently clinically dead (corpse-a "real" cadaver imo)...

I resent the rhetorical tricks-(see below), and politically correct language that has crept into this medical/scientific topic. Using the choice of terms which we are increasingly being led to use,(and actually must use for accuracy even if they mean the OPPOSITE of what they really mean) is beginning to look more like BS of the most disgusting Orwellian variety because it has to do with people's innate rights as human beings. Why should WP go-along with that agenda? WP should HELP people sort it all out not promote this Doublespeak 24.0.133.234 (talk) 15:29, 6 March 2014 (UTC)

I think I discussed this below so I'm going to reproduce here what I said there. "It is true that most organ donation, aside from kidneys, is performed in the context of brain death. The fact that the reference is poor means that we need to find a better reference but the sentence should be restored (perhaps with the modification about kidneys) with a cite needed tag. As well, the fact that most organ donation does take place in this context means that it is reasonable to include a brief summary of the main article." I'd like to add that hearts and lungs can only come from someone who is brain dead.

I think there must be other references for this statement, possibly that use other language; I do agree that an about.com article isn't the best reference. Ca2james (talk) 16:12, 6 March 2014 (UTC)

Organ Donation?

Why is there a section on Organ Donation (and religious views on organ donation) in this article? Seems like it would maybe be better to simply have link to the Organ Donation WP and discuss such issues over there --BoboMeowCat (talk) 05:07, 6 March 2014 (UTC)

I agree. There are even sections on brain death and religious views on that page already. Funcrunch (talk) 05:13, 6 March 2014 (UTC)

Also, this (reverted) edit by 24.0.133.234 was quite blatantly not NPOV. Funcrunch (talk) 06:29, 6 March 2014 (UTC)

I think that there is too much unrelated organ procurement and transplant information in this article as well. The sub-topic does belong maybe as views and opposing views on why the topics are related or maybe just why the topics are related if that is possible?24.0.133.234 (talk) 14:57, 6 March 2014 (UTC)

And you know what Funcrunch- I thought that the topic was going off-track with all of that business about driver's licenses, (I did not start that just added more references and corrections) but as it turns out, there was some really GOOD information to be found. This "default" affirmative choice for organ donation on DLs CAN have an impact on whether or not someone is even resuscitated, or even started on mechanical ventilation, which has a great deal of relation to brain death diagnoses.

I think the DL ifno. should be moved to organ donor, and WHY would a TED talk which also included a(nother) reference to the source of a psychological study which points out that NOT giving people an option to plainly say -N-O- to organ donating (by using techniques and device of mental illusion and confusion with the negative choice meaning an affirmation to donating)....why would you want to CENSOR that as NPOV? I don't understand. Censoring and only presenting YOUR ideas is where NPOV slant occurs.24.0.133.234 (talk) 15:12, 6 March 2014 (UTC)

A discussion of the psychology of how people perceive and make their choices based upon the wording of a question belongs in an article on that topic. It is true that most organ donation, aside from kidneys, is performed in the context of brain death. The fact that the reference is poor means that we need to find a better reference but the sentence should be restored (perhaps with the modification about kidneys) with a cite needed tag. As well, the fact that most organ donation does take place in this context means that it is reasonable to include a brief summary of the main article. I haven't read the organ donation page closely but I suspect that this section doesn't adequately summarize it and needs work.

I agree that the info about who opts in/opts out of organ donation and how they do it (there's much more to this than driver's licences) belongs in the main article on organ donation, not here. I also agree that the religious views on organ donation belongs in the main organ donation article as a summary of its main article (I don't know if its an adequate summary, either). Finally, I think that there's a place in this article for a discussion on religious views with respect to brain death, which is missing. Ca2james (talk) 16:01, 6 March 2014 (UTC)

24.0.133.234 (talk), it was your wording that I take very strong issue with. "Organ recovery advocates have used psychological confusion to promote donation" (emphasis added) is clearly not NPOV, nor does it accurately reflect what was said in the TED talk you cited. It is stating your personal opinion about what the source means. Your opinion is original research, and it is not censorship to require you to include only what the sources actually say in this article. If the TED Talk included another reference with a psychological study then include a cite to that reference and word your edit in a neutral way.

I strongly suggest that you (re)read Wikipedia's policy on NPOV, along with this essay on verifiability before either making any further edits or accusing others who challenge your edits of "censorship". Funcrunch (talk) 17:15, 6 March 2014 (UTC)

I used my own wording because that is what we are supposed to do on WP. I also provided the exact quotation so that readers could see the difference. You had an objection about the "overly long quote"-being used, so which is it? Well-what would you have me do? Copy word for word? In this case I used the word "confusion" to describe the quoted "intentional illusion" of choice that is being given. That was in good faith and but it was intended to show that SOMEONE there obviously had an AGENDA to obtain a MIS-INFORMED (therefore invalid actually)-"donor consent"-ok?24.0.133.234 (talk) 18:18, 6 March 2014 (UTC)24.0.133.234 (talk) 18:19, 6 March 2014 (UTC)

I do not believe you are editing in good faith. Your edits on this and other articles have shown a clear pattern of bias and an attempt to advance your own viewpoints under the ruse of providing a "neutral point of view". You have been warned of disruptive editing numerous times over the past year. Once again, this is an encyclopedia, not a place for you to advance a personal agenda. Funcrunch (talk) 18:34, 6 March 2014 (UTC)

Undone/Removing vital organs cause clinical/cardiac death but since legal brain death has been established, cause of death is noted as whatever caused the state known as brain death and date of death is generally listed as the date upon which brain death

I added a little more, but why was this deleted in the 1st place. Deletion undone pending discussion here please. Is it always mandatory to included cite? A tag would save content better imo. This was my edit to the article on January 17 and about a month later it was removed here---> http://en.wikipedia.org/w/index.php?title=Brain_death&diff=next&oldid=59446874924.0.133.234 (talk) 16:41, 6 March 2014 (UTC)

The statement is WP:OR, is false, and has no references. You are inappropriately expressing causality where none exists and weaseling a definition. Brain death is legal death and cause of death is whatever caused the legal death. The statement doesn't belong on wikipedia. Ca2james (talk) 17:03, 6 March 2014 (UTC)

Yes, it is always mandatory to include citations. This is an encyclopedia, not a discussion forum. See the essay on verifiability I posted above. Funcrunch (talk) 17:18, 6 March 2014 (UTC)