Brain Death

The term "Brain Death" has an ominous implication, and rightfully so, but is occasionally wrongfully used with tragic consequences.

Brain death is defined by medical authorities as irreversible cessation of all brain activity. Simply stated, this means that the brain is no longer alive and cannot be brought back to life.

The determination of brain death depends on very definite clinical and laboratory findings.

Clinically, a person is brain dead when all of the following conditions are met:

1. There are no spontaneous respirations (the person cannot take a single breath on his/her own).
   
   
2. The pupils are dilated and fixed (the black of the eyes is wide and does not react to light).
   
   
3. There is no response to noxious stimulation (painful stimulation provokes no eyeblink, no grimacing, no movements of any part of the body).
   
   
4. All extremities are flaccid (there is no movement, no muscle tone and no reflex activity in any of the limbs - arms or legs).
   
   
5. There are no signs of brain stem activity:
   
   
1. The eyeballs are fixed in the orbits.
   
   
2. There are no corneal reflexes (stroking the clear part of the eye with a fine wisp of cotton fails to produce any movement of the eyelids).
   
   
3. There is no response to caloric testing (exposing the tympanic membrane of the ear to ice cold water fails to produce movement of the eyes).
   
   
4. There is no gag reflex or cough reflex.

If all of the clinical criteria of "brain death" have been met, a person cannot be declared "brain dead" until the physician has made sure that no opiate drugs (ex. codeine, demerol, morphine, cocaine, heroin) and no barbiturate drugs (ex. phenobarbital, secobarbital, nembutal, amytal) have been administered in the previous 24 hours and that brain death has been confirmed by one of the following diagnostic studies:

1. Cerebral angiogram (injection of a dye into the arteries of the neck to show the arteries of the brain on x-ray films), showing no penetration of dye into the arteries of the brain.
   
   
2. Cerebral blood flow scan (scan of the head after intravenous injection of a safe radioactive substance) showing no blood flow in the brain.
   
   
3. Two EEG’s (electroencephalograms or brain-wave tests) at about 24-hour intervals showing no electrical activity coming from the brain, i.e., flat or isoelectric tracings.

The third of the above three tests is the most commonly used because it is the most easily performed at the patient’s bedside.

It is only when all the five described clinical criteria in a person on no opiate or barbiturate medication for at least 24 hours and with confirmation by one of the three diagnostic studies have been met that a patient can be declared "brain dead".

A "dead" brain has never been known to recover, even though heart and lung function as well as kidney function can be maintained by artificial means for many days and sometimes two or three weeks.

Modern medicine and technology can maintain bodily functions (except brain function) for exceptionally and painfully long periods of time with one recorded case of brain death lasting 45 days before heart and kidneys failed to respond to artificial "life" support measures.

No "brain dead" person shall ever be put on a coma arousal program.

Mihai D. Dimancescu, M.D.
Director of International Coma Recovery Institute
Chairman Emeritus, CRA

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