What is brain death?
posted in - General, - Palmdoc |The Star today has an article on Need for docs to be upfront with regards to “brain death”. Before one is upfront, one (both doctors and patients) need to understand what brain death is. Is it:
a) loss of cerebral function when someone gets elected as Member of Parliament?
b) absence of higher mental functions seen when teenagers talk on the phone or when attached to their iPods?
c) permanent and total loss of brain stem function
d) all of the above
If you chose c) then you’re correct though a) is not very far off the mark!
Universiti Malaya anaesthesiology and critical care Professor Emeritus Datuk Dr Alex Delilkan said keeping brain dead patients on a ventilator and charging their families for it could be “ethically and morally wrong” and open the doctors to lawsuits.
Dr Delilkan: ‘Family members cannot decide what doctors should do professionally’
It would also deprive other critically ill patients of hospital facilities, he said.
“Even if family members protest and refuse to let doctors remove the ventilator, they cannot decide what doctors should do professionally,” he said, adding that family members would often claim that the electrocardiogram showed the person was still alive.
This was because they did not realise that drugs kept the patient’s heart beating and mechanical support kept the lungs working but the person was actually dead.
Such a situation usually arose when doctors did not explain to the family members early enough on the possibility of brain death in intensive care, said Dr Delilkan.
When he first set up the intensive care unit in 1968 in the then-Universiti Hospital, Dr Delilkan said he had noticed that despite doctors resuscitating patients, some patients’ bodies began to stink and decompose.
He said that in Malaysia, a medical consensus on brain death had been compiled in 1993 and updated 10 years later.
In Malacca, A. L. Loh, 39, recalled that her father could not accept the sudden death of her mother two years ago from bacterial infection when the doctor told them she was brain dead.
Some cultures and religious scholars hold the misconception that if the heart is still beating, the person is alive. This could not be further from the truth. Brain death is actually better described as Brain Stem Death. The brain stem is the lower, more primitive part of the brain which controls vital functions like breathing and your heart function. Once the brain stem dies, the rest of the body will follow suite. Artificial methods like ventilators and drugs like inotropes can keep the blood pressure up and heart beating for short time but once brain stem death occurs, it’s only a matter of time.
I located the Guidelines for determining Brain Death in the Malaysian Paediatrics Association here (PDF format)
Technorati Tags: brain death, dying, ICU, ventilation, brain stem
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October 1st, 2006 at 4:12 pm
It’s best to be certified by 2 senior doctors independently, but I find the 12 hour pre-condition a bit too short. If the relatives are still not accepting the verdict, one or two days delay to me is very reasonable. Personal non-expert level 5 a simple man’s opinion.
‘Family members cannot decide what doctors should do professionally’ – still best if we can get next of kin to agree with our action if possible.
But that bit about ‘despite doctors resuscitating patients, some patients’ bodies began to stink and decompose’ is simply unbelievable. Sounds exaggerated to me.
October 2nd, 2006 at 7:19 am
Probably the smell of necrotic tissue from infected pressure sores…. But what Prof Delilkan says it’s true. I think doctors and relatives should really look at the whole picture and think if their are not prolonging life, but in actual fact prolonging death…
October 2nd, 2006 at 7:14 pm
My non-evidenced based opinion is 12 hours feels a bit short too, particularly for the family to come to grips with the reality of losing a loved one. But I think it could be related to the period for viable organ onations. Any transplant surgeons out there?