February 27, 2009

Be Our Guest / Dr. Edward J. Dropcho

Doctor: Story on brain death raises important points to consider

I am writing in regard to the article on brain death in the Feb. 6 issue of The Criterion.

It is important to reiterate that Pope John Paul II and, more recently, the Pontifical Academy of Sciences fully supported the concept of “brain death” or “total irreversible brain failure” as equivalent to death of an individual.

The term “brain death” itself is somewhat misleading in that it implies that there is more than one kind of death.

A more correct concept is that death is a unitary event, which can be diagnosed either on the basis of cessation of breathing and heartbeat or on the basis of total irreversible brain failure.

There are specific and rigorous procedures and criteria which must be followed by physicians in correctly making the diagnosis of “brain death.”

One of these criteria is that the brainstem control of breathing is irreversibly lost so that the patient cannot and does not take any spontaneous breaths when disconnected from a ventilator. Any spontaneous breathing movement, even if intermittent or ineffective, is automatically incompatible with the diagnosis of brain death. A patient who is truly brain dead, when disconnected from the ventilator, inevitably suffers cardiac arrest within a few minutes.

Brain death is completely distinct from other states of brain injury, and should never be confused with such disorders as vegetative state, minimally conscious state or locked-in syndrome. Persons with any of these other disorders do have some likelihood (although sometimes very small) of partial recovery.

In stark contrast, a person who fulfills the diagnostic criteria for brain death has zero chance of recovery. There is not a single well-documented instance in the medical literature of a person recovering any neurologic function whatsoever—including breathing—after the diagnosis of brain death has been made in a careful and correct manner.

It was wonderful to read about the recovery of Raleane Kupferschmidt. However, I strongly suspect that she was not—and could not have been—“brain dead” in the first place.

The diagnosis may have been made in error (which should never occur), or there may have been some miscommunication between health care givers and family, or Kupferscmidt made a recovery which is unprecedented in the nearly 30 years since modern brain death criteria have been applied.

There are two other important points which this article brings to mind: 1) It is the physician’s duty to be absolutely rigorous and meticulous in making the diagnosis of brain death. A person who does not fulfill the strict diagnostic criteria should NEVER be diagnosed as “brain dead.” 2) It is the responsibility of the press to be medically accurate and careful in their language so as never to confuse brain death with potentially reversible neurologic disorders.

(Dr. Edward J. Dropcho is a professor in the Indiana University Department of Neurology and a member of Immaculate Heart of Mary Parish in Indianapolis.)

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