Until the 1950s, there was no distinction between brain death. When the heart stopped, the brain that
What has changed in the definition of human death?
In the 1950s, diagnostics was changed by the advent of new resuscitation and life-saving procedures. Three of them are especially important.
- Cardiopulmonary resuscitation (CPR)- a whole range of actions that are needed forin order to restore the vital functions of the body and bring it out of the state of clinical death. Among them are direct or indirect cardiac massage. It can be different: you can put pressure on the chest, use a defibrillator, or open the sternum to gain access to the heart muscle.
- The artificial ventilation system is lightx is the use of a device to facilitatethe movement of air into and out of the lungs is carried out in various ways. Typically, a plastic tube is inserted through the nose or mouth into the windpipe (trachea). If people need mechanical ventilation for more than a few days, doctors may insert a tube into the windpipe through a small cut in the front of the neck (tracheostomy). The tube is then attached to the ventilator. A ventilator can blow air into the lungs even if a person is unable to do so. Muscle relaxants are used during the procedure.
- Extracorporeal membrane oxygenation (ECMO)— invasive extracorporeal saturation methodblood oxygen in the development of severe acute respiratory failure. When performed, the blood is pumped through a special apparatus that saturates it with oxygen.
With the help of all three procedures, even if the braindoes not function, it is possible to maintain the life of the body and the functioning of other organ systems. At least for a while. As a result, a person may look alive and, in fact, is so. But due to brain death, “consciousness” has already “left” him. Only the shell remained.
How does the brain die?
Brain death, also known as neurological death, occurs when there is severe trauma and prolonged lack of oxygen.
Due to injury or lack of oxygen, brain cellsbegin to die, which causes inflammation and swelling. These processes lock the brain into a vicious feedback loop: damage leads to swelling, which leads to more damage. This is because thin nerve cells are closely pressed to the hard shell.
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The brain stem is compressed through the largeoccipital foramen. It is located at the base of the skull, where the spinal cord connects to the brain. This damages the areas that control breathing and heartbeat. Increasing pressure inside the skull makes it difficult for blood to reach the brain. More and more cells die. Once they disappear, their complex connections with each other are lost, resulting in irreversible damage. The process worsens, and eventually brain death becomes inevitable.
Even if the patient's other organs are still receiving oxygen through the ventilator, sooner or later multiple organ failure will occur and the patient will stop responding to treatment. The body shuts down.
How is brain death diagnosed?
Before you announce the man with the beating heartdead, brain death must be confirmed using special tests. This will make it possible to abandon artificial life support and useless treatment or, in some cases, use a person for organ donation. The examination should be performed by an experienced neurologist or neurosurgeon.
The doctor must know the cause of the patient's condition,which corresponds to catastrophic damage to the entire brain. Toxins, drugs, or any other potentially reversible cause must be ruled out.
If all conditions are met and factors are taken into account,doctors perform a clinical examination, testing reflexes that depend on the functioning brain stem. For example, do the pupils react to light? There are also tests that involve the gag reflex and other automatic muscle movements.
If the patient has no signs of reflexesbrain stem, doctors perform a final test for apnea: they remove the patient from mechanical ventilation to see if the person begins to breathe spontaneously. A patient with brain death is not able to do this on his own.
What is the main difficulty?
The problem is the rules for diagnosing brain deathmay vary from country to country. Issues also arise with respect to the religious beliefs and philosophical and ethical views of the patient's family or medical attorneys.
In addition, the patient's relatives may not agree with the doctor's assessment that their relative's condition is irreversible. Also, the possibility of a medical error in the diagnosis is not excluded.
In addition, there is debate about whether brain death should include more tests or criteria.
The situation is further complicated by the fact that often deaththe brain is sudden, for example, as a result of urgent surgery or accidents. Therefore, the loss of a loved one is often unexpected and extremely difficult to perceive. Especially if it seems that the human body is still alive.
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