Defining Death

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Defining Death

You have been told that someone is lying on a bed, their mind, for all intents and purposes is no longer functioning. Their internal organs, however, are. You are asked if it would be okay to remove the organs for transplantation. What do you do? As much as this question sounds like science fiction, there are 10,000 people living on life support in the United States.

There has been a long held rule of thumb that when the heart beat and breathing have stopped, a person was considered dead. One doctor wrote of having to pronounce death on a man when he was still an intern. He relied on a EKG, and electrocardiogram, something that measures the heart rate, to give him his final conclusion of death. To use only that criteria is becoming a grayer and grayer area as medical technology progresses and other issues begin to take the fore. We are now capable of sustaining bodies for extended periods of time and also are now able to transplant organs from one person to another. For obvious reasons you cannot transplant certain organs from human beings without the donor first being dead, and then you have a very limited time within which you must "harvest" the organs. Just because part of the nervous system is functioning does not necessarily mean the rest of the nervous system is. Many people from different walks of life feel that as soon as "higher" functions cease and someone is brain dead, then their organs are fair game if they had previously decided to donate them. (2) That sentiment, while understandable, begs another question, how do you tell when these functions cease?

According to a commission done in 1981, brain death can be determined by the following criteria; unresponsiveness (person does not respond to any external stimulus and cannot communicate with the outside world,) an absence of cerebral and brain stem function (pupils are unchanging, no gag reflex, limbs are flaccid,), nature of coma is known, must rule out hypothermia, drug intoxication and the person is not in shock. Also, you must have 12 hours without an EEG response or other EEG measure. There are also confirmatory things to look at, but these are not required, you can have an EEG with no activity, no cerebral blood flow, and no function in vital brain stem areas. (4) This can be summarized by saying that the brain has to totally cease functioning.

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