The problems in hospitals determining brain death
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The debate over these questions has continued for decades.
In 1968, Harvard Medical School published brain death criteria. By 1981, the Uniform Determination of Death Act was approved by the National Conference of Commissioners on Uniform State Laws, with the intent of providing a comprehensive and medically sound basis for determining death in all situations. These efforts did not achieve consensus. Instead, defining brain death is left largely to the discretion of the doctor or institution. This means that at one hospital a patient could be considered “brain dead” and treatment stops, while at another facility a patient is not ruled “brain dead” and care continues. Some patients have regained consciousness at one facility, and gone on to live their lives, but would have long been deceased if they had been at a different hospital. Recent technological advances in medicine have added diagnostic insight in determining brain death. In 1994, a device for anesthesiologists called the BIS monitor (bispectral index) was introduced. One of the major concerns of anesthesiologists is giving the correct amount of anesthetic—enough to bring about unconsciousness and prevent the patient from feeling and perceiving the surgery, but not too much, which could cause complications. This is where the BIS monitor comes in. The BIS monitor produced a score on a scale of 0 to 100, with 0 being dead and 100 being normal/totally conscious. Anesthesiologists look for a BIS score in the 40 to 60 range, which indicates successful anesthesia. A small Brussels study shows that the BIS monitor can have use outside the realm of anesthesiology. In that study, five patients who were evaluated as “brain dead” were hooked up to a BIS monitor. The results were surprising: o 3 out of 5 had a BIS value of > 0 (inconsistent with brain death) o 1 had a BIS value of 0 o 1 had a value of 90 during the apnea test (inconsistent with brain death) Similarly, organ procurement (transplantation) teams have anecdotally reported that they have canceled organ harvesting procedures because the BIS value was inconsistent with brain death. Although utilization of BIS monitoring is not yet the standard of care for anethesiologists, its use in that application as well as in assessing brain death looks promising.  Robert Painter is an attorney and member of Painter Law Firm PLLC. Opinions expressed on Painter Law Firm are those of the author only and do not necessarily reflect those of Painter Law Firm. Opinions and comments do not establish an attorney-client relationship.
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