Controversies and updates regarding brain death and non heart-beating organ donation

What is the understanding of the conceptual basis by pediatric intensivists in Canada? (Archives of Pediatrics and Adolescent Medicine)

The precise moment of death eludes detection by current medical and philosophical analyses. Should the definition of death be modified from a biologic to an ontologic model? (Leslie M Whetstine, Duquesne University, Pittsburgh, Pennsylvania, USA)

Pro/con debate explores the ethical issues surrounding non heart-beating organ donation (NHBD): "The critical care forum": Leslie Whetstine, Duquesne University, Pittsburgh, Pennsylvania, USA; Kerry Bowman, Bioethicist, University of Toronto, Joint Centre for Bioethics, Ontario, Canada, and Laura Hawryluck, Assistant Professor, Critical Care Medicine, Joint Center for Bioethics, University of Toronto, Canada.

1.-) Brain Death: Understanding of the Conceptual Basis by Pediatric Intensivists in Canada. In: Archives of Pediatrics and Adolescent Medicine, July 2006; Vol. 160, No.7, p.747-752. Article written by Ari R. Joffe, MD, Natalie Anton, MD.

"Objective: To determine whether pediatric intensivists in Canada are aware of the controversies regarding the concept of brain death (BD). Design: Prospective survey.

Setting: From February to April 2004, a survey was mailed to each intensivist in the 15 pediatric intensive care units across the 8 provinces of Canada. Participants Sixty-four practicing pediatric intensivists. Main Outcome Measures Response rate, conceptual reasons to explain why BD is equivalent to death, and clinical findings that exclude a diagnosis of BD.

Results: Of the 64 surveys, 54 (84%) were returned. When asked to choose a conceptual reason to explain why BD is equivalent to death, 26 (48%) chose a higher brain concept, 17 (31%) chose a prognosis concept, and only 19 (35%) chose a loss of integration of the organism concept. More than half the respondents answered that BD is not compatible with electroencephalographic activity, brainstem evoked potential activity, or some cerebral blood flow. More than a third of respondents answered that a brainstem with minimal microscopic damage was not compatible with BD. Of the 36 respondents who answered they were comfortable diagnosing BD because 'the conceptual basis of brain death makes it equivalent to death of the patient,' in their own words, only 8 (22%) used a loss of integration of organism concept, 9 (25%) used a prognosis concept, 7 (19%) used a higher brain concept, and 13 (36%) did not articulate a concept.

Conclusions: There is significant confusion about the concept of BD among pediatric intensivists in Canada. The medical community should reconsider whether BD is equivalent to death."

Author Affiliations: Division of Pediatric Intensive Care, Department of Pediatrics, University of Alberta, Edmonton.

2.-) "Bench-to bedside review: when is dead really dead? On the legitimacy of using neurologic criteria to determine death". In: Critical Care 2007, by Leslie M Whetstine, Duquesne University, Pittsburgh, Pennsylvania, USA.

===> Full version of this article (PDF, 40 Ko): click here.

3.-) "Pro/con ethics debate: is nonheart-beating organ donation ethically acceptable?"

Abstract:
"This pro/con debate explores the ethical issues surrounding nonheart-beating organ donation (NHBD), a source of considerable controversy. It is estimated that NHBD can increase the number of organs available for transplant by 25 per cent at a time of great need. However, should NHBD be ethically acceptable? In support of NHBD, it may be acceptable practice if there is a separation of the rationale to withdraw life support/to withhold cardiopulmonary resuscitation from the decision to recover organs, if no conflicts of interest exist, if a waiting time precluding spontaneous return of circulation is included, and if NHBD conforms to a standardized protocol. Against NHBD, there are questions regarding the ambiguity and cultural perspectives of death, regarding whether a separation of rationale between withdrawal and donation is sufficient to preclude conflicts of interest, and regarding whether variable protocols arise that subordinate the patient to the goal of donation. Such concerns suggest NHBD may damage the trust in patient–physician relationships and may adversely affect organ donation rates."

==> Read the full article: click here.
Source:
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=137443