Originally Posted by NeuroICURN Sounds to me like these cases, if true, then the MDs need a lesson in not only properly declaring brain death, but also on what brain death is. In the case of the person breathing spontaneously.....well that is one of the criteria, the person CAN NOT be breathing spontaneously....if they are, they are NOT brain dead, yet.
As for the third case you cited...you did not say that she was ever declared brain dead....more sounds like they were withdrawing care. Also, one CANNOT be declared brain dead, when there are certain things in the bloodwork that could even just possibly explain them not responding normally.
I'm sorry if I misrepresented the authors' position in this article, or my own - the point was not that these were case where brain-dead patients became "un-brain-dead" (for want of a less clumsy phrase). Rather it is that determinations of brain death are sometimes made when patients don't fit the criteria. In the cited cases, these reasons may have included inevitable somatic death (or perceived inevitable somatic death), a viable recipient in the wings, or perhaps even financial aspects (this last is not explicit in the text).
I agree with you, NeuroICURN, that these cases describe patients who are
not brain-dead - that was the point of the article. The reason I posted it is that, if relatives are told that a patient is brain-dead and s/he isn't, or isn't yet, or is brain damaged, then this muddies the waters for everyone. The term 'brain dead' is thrown around a lot, and as we can see from the discussion thus far, informed and interested health professionals are not always any clearer about it than lay people. For example, on my unit (which incorporates neurosciences), staff refer to patients as being 'brain dead' when they mean unconscious, unresponsive or hypoxically brain damaged, although they know that part of the definition of brain death is that the patient is ventilator-dependant.
About the third case: although van Norman does not specify that the patient had been declared brain dead, she does say: "On the day of anticipated organ collection..." and "Vital organ collection was canceled..." These phrases seem to indicate that organ collection was planned, timed, rather than related to withdrawal of treatment. It is possible, of course, that treatment was planned to be withdrawn that day, with post-mortem organ retrieval, which would seem to be premature. However, as the article is specifically about declaring brain death, I think it's safe to presume that the third patient had been declared brain dead like the other two.
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