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brain death

English term

brain death, cerebral death

definition

The term brain death refers to the no longer existing and irreversible activity of vital brain areas ( cerebrum, cerebellum, brainstem ) in a cardiovascular function which is still maintained by artificial respiration (Scientific Advisory Council of the German Medical Association, 1997). Brain death means the death of man in a scientific and medical sense.

lobes

Frontal lobe = red (frontal lobe, frontal lobe)
Parietal lobe = blue (parietal lobe, parietal lobe)
Occipital lobes = green (occipital lobe, occipital lobe)
Temporal lobe = yellow (temporal lobe, temporal lobe).

diagnostics

To determine the irreversibility of the brain activity, certain medical examinations as well as apparatus procedures and certain observation times are required. The scientific advisory board of the German Medical Association (1997) issues the following guidelines for the diagnosis of brain death:

  1. requirements
    To determine the brain death, either a primary (severe head injury, etc.) or a secondary brain damage (due to lack of oxygen, etc.) must be present. In addition, intoxication and pathological processes must be excluded.
  2. Symptoms of brain function loss are loss of consciousness (coma), tightness of the pupil (pupils no longer respond to light stimuli), lack of reflexes and lack of spontaneous breathing.
  3. Irreversibility of the failure symptoms
  4. The observation duration of the failure symptoms must be between 12 hours and three days. Additional equipment tests are necessary to diagnose brain death. One such technique is electroencephalography (EEG), which measures the activity of the brain. In the electroencephalogram there is no baseline activity (zero-line finding) or reaction to visual, auditory or tactile stimuli (evoked potentials, EP) and no blood circulation in the large vessels (arteries and veins) can be detected by Doppler sonography. Thus, these findings in the context of the other investigations confirm that the brain death has occurred.

    Detection of brain death

    The brain death must be determined by two physicians, one of whom must have several years of experience in intensive care with patients with severe brain damage.
    Independently of each other, brain death is recorded by the two doctors using a standardized protocol.


    Contrary to the assumption that the time of death is the time of death, it actually means the time of the completion of the diagnosis and documentation of brain death.

    None of the two doctors diagnosing brain death may subsequently participate in an organ transplant.

    organ transplantation

    Only after detection of the brain death (guidelines of the German Medical Association 1997, see above) may in the context of §3 of the Transplantation Act, the removal of tissue or organs are made, unless the deceased person or relatives have objected to the organ / tissue removal.

    Criticizing the brain death definition

    Especially after the Erlanger case of Marion P. criticism was made on the brain death definition. Marion P. was admitted to Erlangen University Hospital on 5 October 1992 with severe craniocerebral injuries. Three days later, the patient was diagnosed with brain death. Since the patient was pregnant, the further intensive care treatment was decided until childbirth. After five weeks, however, there was a fever episode of the brain-dead patient and then a miscarriage. Due to this case, there is a particular criticism of the definition of brain death, since an already dead female patient can neither develop a fever nor have a miscarriage. This means that despite the lack of brain activity, various other systems (spinal cord, organs) can still be active.

    Several other scientists also have critical opinions on brain death definition.

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