Brain Death and Life Support System

By the end of 1980, a rule was passed by Washington Supreme Court under which “brain death” was considered to be a “legal” method to determine death. Under this verdict death was defined as “irreversible cessation of all functions of entire brain, including brain system”. Death of the brain usually results from the absence of the “cerebral blood flow” due to a severe brain injury or “critical illness. This type of death is usually affirmed by the “clinical neurological examination” along with a “positive apnea test”. (EElco, Pg: 7)Brain Death and Life Support System

Under the “Uniform Determination of Death ACT” of US any man whose brain is dead will be considered dead. However, one must keep in mind that there is an evident “difference between brain death and severe brain damage”. It is important that the doctors should be capable to recognize this difference because in case of brain death the continuation of life support treatment is of no use.  (EElco, Pg: 7)

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The main reason of brain death in adults is “traumatic brain injury and subarachnoid hemorrhage”. However, cruel abusive measures, road accidents and “asphyxia” cause brain death in children. The discontinuation of“mechanical Ventilation” can only take place when a patient has been clinically diagnosed of having a dead brain. However, the physicians are not authorized to discontinue the “mechanical ventilation” due to ethics and lawful duties. For instance, if a patient is suffering from “invariant heart rate from differentiated sinoatrial node, structural myocardial lesions leading to a marked reduction in the ejection fraction, decreased coronary perfusion, the need for increased use of inotropic drugs to maintain blood pressure and fragile state that leads to cardiac arrest within days or weeks”. (EElco, Pg: 7)Brain Death and Life Support System

A study was conducted to correlate the manner of death and the components responsible for the removal of the life support system in a “Pediatric Intensive Care Unit”. This study was specially focused towards developing countries. About one hundred and forty eight students were analyzed for the study. The age of the children was less than twelve years. It was found that the “limitation” in the life support system led to the death of about sixty eight children, in ability to provide “cardiopulmonary resuscitation” led to the death of sixty one children. However, about twelve chilled lost their life due to the removal of both life support system and “end tracheal tube”. No compelling changes were examined in the extent and division of limited treatment, absence of “active treatment”, and the death of brain during these two states. (Goh et al, Pg: 3)

Besides, certain rise of about eight percent of brain death was experienced as a result of the removal of the life support system during 1997-1998. The life support facility was limited on the account of bring immediate death. However, only seventy one of the seventy five children showed immediate death, families of about twenty one patients refused to remover life support system. It is believed the about fourteen of these families shared “ethnic variability”. The results of the study showed that in developing countries the obvious manner of death is limiting life support treatment. The removal of a life support system is not being used in such countries. This is because the doctors of such countries work under high “socio-culture and religious” pressure. Therefore they have to make their decisions more carefully. (Goh et al, Pg: 3)

Certain surveys conducted in United States of America, United Kingdom, Europe and Japan proves that the cause of that in patients of “Pediatric intensive care” is either removal or “limitation” of a life support system. However, it was found the common manner of the death of crucial pediatric patients is the limited treatment rather than removal of life support treatment. (Goh et al, Pg: 3)

Initially only dead bodies with “non-heart-beating” were certified to donate body organs. However, it was abolished in the initial years of 1970s due to the acceptance of the term “Brain death”. It was found that the organs donated by the brain dead people survived longer than others. (Michael et al, Page 3)Brain Death and Life Support System

It is quite suggestive to remove a mechanical ventilator when the cerebral of a man is not functioning properly and he is undergoing a “vegetative state”. This is so because it is useless to keep a person alive without any hope of recovery for ventilator treatment is quite expensive and shouldn’t be continued pessimistic cases. The death of a brain is different from the death of a brain stem. It usually doesn’t results in death. Death is only suggestive when both brain and the stem of the brain die. The function of hear and breath is controlled by the stem of the brain. Hence, it is necessary for the death of the brain stem before declaring the death of the person.  However the life support system should only be removed by the chances of the patients revival are in negative. However, it may only be done on the basis of “scientific assessment”. The physicians should be capable to distinguish between the deaths of a brain a brain stem only then they should discontinue the treatment of a mechanical ventilator. It is important that the doctors should be capable to recognize this difference because in case of brain death the continuation of life support treatment is of no use (Michael et al, Page 3)

A “cross-sectional and multi center” research was conducted in Brazil to interpret the events concerning the brain death and its “medical management”.  The study was distributed over about 7 “intensive care units” situated in three different areas of Brazil. The hospitals selected for the studies were “Porto Alegre, Sao Paulo and Salvador”. Tow of the “PICUs” staff members were given the training of the collecting certain information relating to “demographics”, the reasons of the patients death, the time of being diagnosed of having brain death and the certain medical treatment provided since then. (Patricia et al, page: 3)Brain Death and Life Support System

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The data was gathered form five hundred and twenty five patients. Of these about sixty one were considered to be suffering from brain death. The major cause of brain death found till now was “Intracranial hemorrhage” in about eighty percent of the patients of the three hospitals. However, the only major difference found in the three different areas of the Brazil is the time difference of diagnosing the brain death and the removal of the life support treatment. The conclusion of the study shows that the patients of Brazil rely more upon the life support system. They seem to keep their patients alive for an unnecessarily large period of time. It is not that the Brazilian physicians are unable to recognize the brain death. They do have a “Law” retaining to the criteria however, they are quite hesitant to follow it in a strict manner. And hence give their expensively painful life. (Patricia et al, page: 4)

The invention of he “mechanical ventilation” give birth to the age where bodily organs can organs for a prolong period of time without the presence of an active brain. It means that the body can still be kept alive despite the death of the brain. The death of the brain can better be defined as “loss of full brain function, characterized by deep coma, apnea and lack of supraspinal reflexes”. In short, brain death is medically and ethically an individual’s complete death. (Patricia et al, page: 4)

This is because whose function of the body stops with the death of the brain. The death of the brain is considered differently in different countries. For instance in US it is ample to declare a person with brain death however in many countries does not consider the death of the brain unless certain reports like “ absences of electrical and metabolic functions or of the cerebral flow” has been confirmed. Mostly, a declaration done by at least two doctors is an affirmation of brain death. It is a signal that the patients are dieing and henceforth we freed of the life support treatment. (Wijdicks, Pg: 1215)Brain Death and Life Support System

However, the acceptance of the death of the patients mostly physicians are hesitant to withdraw mechanical ventilation from the patients with dead brains but and an alive heart. This hesitancy is due to conflicts among the physicians and the members of the family.  The situation is even crucial in case of the involvement of the “personal and religious” norms and values. Certain societies and religions don’t affirm death unless all the parts of the body have died. Therefore, for them the withdrawal of the life support system results in distress. This is because the individual’s body is still alive on the basis of the support treatment.

The removal of the life support system in case of a brain death is only possible after consulting the family. However, despite all the arguments given here the fact is that the physicians all over the world are unable to critical towards the management of the aftermaths of the brain death. It creates “anxiety in the medical community” globally. The proper and efficient managing of the brain death phenomena is not uniformly managed worldly. Is has to under several cultural and religious in equalities. (Patricia et al, page: 5) Brain Death and Life Support System