Brain Death and Disorders of Consciousness PDF
Preview Brain Death and Disorders of Consciousness
BRAIN DEATH AND DISORDERS OF CONSCIOUSNESS ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY Editorial Board: NATHAN BACK, State University of New York at Buffalo IRUN R. COHEN, The Weizmann Institute of Science DAVID KRITCHEVSKY, Wistar Institute ABEL LAJTHA, N. S. Kline Institute for Psychiatric Research RODOLFO PAOLETII, University of Milan Recent Volumes in this Series Volume 540 OXYGEN TRANSPORT TO TISSUE, VOLUME XXV Edited by Maureen Thomiley, David K. Harrison, and Philip E. James Volume 541 FRONTIERS IN CLINICAL NEUROSCIENCE: Neurodegeneration and Neuroprotection Edited by Laszlo Vecsei Volume 542 QUALITY OF FRESH AND PROCESSED FOODS Edited by Fereidoon Shahidi, Arthur M. Spanier, Chi-Tang Ho, and Terry Braggins Volume 543 HYPOXIA: Through the Lifecycle Edited by Robert C. Roach, Peter D. Wagner, and Peter H. Hackett Volume 544 PEROXISOMAL DISORDERS AND REGULATION OF GENES Edited by Frank Roels, Myriam Baes, and Sylvia De Bie Volume 545 HYPOSPADIAS AND GENITAL DEVELOPMENT Edited by Laurence S. Baskin Volume 546 COMPLEMENTARY AND ALTERNATIVE APPROACHES TO BIOMEDICINE Edited by Edwin L. Cooper and Nobuo Yamaguchi Volume 547 ADVANCES IN SYSTEMS BIOLOGY Edited by Lee K. Opresko, Julie M. Gephart, and Michaela B. Mann Volume 548 RECENT ADVANCES IN EPILEPSY RESEARCH Edited by Devin K. Binder and Helen E. Scharfman Volume 549 HOT TOPICS IN INFECTION AND IMMUNITY IN CHILDREN Edited by Andrew J. Pollard, George H. McCracken, Jr., and Adam Finn Volume 550 BRAIN DEATH AND DISORDERS OF CONSCIOUSNESS Edited by Calixto Machado and D. Alan Shewmon A Continuation Order Plan is available for this series. A continuation order will bring delivery of each new volume immediately upon publication. Volumes are billed only upon actual shipment. For further information please contact the publisher. BRAIN DEATH AND DISORDERS OF CONSCIOUSNESS Edited by Calixto Machado Institute of Neurology and Neurosurgery Havana, Cuba . and D. Alan Shewmon David Geffen School of Medicine at UCLA Los Angeles, California ~ Springer Proceedings of the IV International Symposium on Coma and Death, held March 9-12, 2004, in Havana, Cuba ISSN 0065-2598 ISBN 978-1-4757-0976-6 ISBN 978-0-306-48526-8 (eBook) DOI 10.1007/978-0-306-48526-8 © 2004 Springer Science+Business Media New York Originally published by Springer Science+Business Media in 2004 Softcover reprint of the hardcover 1s t edition 2004 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, Inc., 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now know or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks and similar terms, even if the are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. 98765432 springeronline.com PREFACE Calixto Machado and D. Alan Shewmon* Since ancient times, Christians and Hebrews considered breath or ruach as the hallmark of life. Greeks believed that heartbeat delimited the frontier between life and death. Therefore, over the centuries people were deemed dead when they stopped breathing and their hearts stopped beating. The great pandemic disasters and the need for early burial prompted a worldwide fear of being buried alive. Winslow, in 1740, emphasized that putrefaction was the only sure sign of death. Nevertheless, the invention of the stethoscope in the middle of the 19th century enabled physicians to detect weak heartbeat and restricted respirations, raising their competence. This partially alleviated public fears of premature burial. The remarkable technological advances of the 20th century radically changed the course of medicine, especially intensive care. The development of effective mechanical ventilators and cardiopulmonary resuscitation ("reanimation") compelled physicians in the late 1950s to grapple with a condition impossible even to imagine previously: one in which the brain is massively damaged and nonfunctional while other organs remain functioning. Is such a patient alive or dead? This state was documented by French neurologists and neurophysiologists at the end of the 1950s. The end of the 1960s witnessed the next major milestone, with the Report of the Ad Hoc Committee of the Harvard Medical School. These years marked a turning point when brain-oriented definitions of death started to be formulated, and brain death (BD) was gradually accepted as death of the individual. Nonetheless, there are still worldwide controversies over the very concept of human death and the putative neurological grounds for diagnosing it (whole brain, brain stem, and higher brain formulations of death). There are also disagreements over the diagnostic criteria of BD, whether clinical alone, or clinical plus ancillary tests. Moreover, a group of scholars who were strong defenders of a brain-based standard of death are now favoring a circulatory-respiratory view. Hence, the debates on human death are far from concluded . • Calixto Machado, MD, PhD, President of the National Commission for the Determination and Certification of Death. Institute of Neurology and Neurosurgery, Havana, Cuba. Email: [email protected]. D. Alan Shewmon, MD, Professor of Neurology and Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095. Email: [email protected]. v VI C. MACHADO AND D. ALAN SHEWMON The sunny city of Havana has become the capital for discussions on human death for more than a decade. The First International Symposium on Brain Death was held in 1992, and the clear consensus among delegates was that the subject of human death was far from over. Delegates from all continents reconvened for the Second International Symposium on Brain Death in 1996 and the Third International Symposium on Coma and Death in 2000. These were remarkable conferences, attended by the most outstanding personalities in the field from multiple disciplines. At the beginning of the new millennium, Havana will once again welcome colleagues from around the globe to hold the Fourth International Symposium on Coma and Death (March 9-12, 2004). This book is a selection of lectures from authors who are prominent scholars in this area. We hope it will serve as a valuable source of knowledge for present and future generations. The motivation to ever deepen our knowledge about human death (and life) is a matter of human dignity. CONTENTS PEULOSOPEUCAL, ETEUCAL, AND LEGAL ISSUES Brain Death: Updating a Valid Concept for 2004 .................. :. ............................. 1 Julius Korein and Calixto Machado The Concept of Brain Death ................................................................................ 15 Jean-Michel Guent The "Critical Organ" for the Organism as a Whole: Lessons from the Lowly Spinal Cord ................................................................... 23 D. Alan Shewmon "Brain Death" Is Not Death ................................................................................. 43 Paul A. Byrne and Walt F. Weaver The Conceptual Basis for Brain Death Revisited: Loss of Organic Integration or Loss of Consciousness? ...................................... 51 John P. Lizza Consciousness, Mind, Brain, and Death .............................................................. 61 Josef Seifert The Death of Death .............................................................................................. 79 James J. Hughes vii viii CONTENTS The Semiotics of Death and Its Medical Implications ......................................... 89 D. Alan Shewmon and Elisabeth Seitz Shewmon About the Continuity of Our Consciousness ...................................................... 115 Pim V ~n Lommel Brain Death and Organ Transplantation: Concepts and Principles in Judaism ............................................................................................. 133 Z. Harry Rappaport and Isabelle T. Rappaport Cuba Has Passed a Law for the Determination and Certification of Death ................................................................................................. 139 Calixto Machado and the National Commission for the Determination and Certification of Death DIAGNOSIS, PATHOPHYSIOLOGY AND TREATMENT Neuroprotection Becomes Reality: Changing Times for Cerebral Resuscitation ......................................................................................... 143 Maxwell S. Damian Controlled Hypertension for Refractory High Intracranial Pressure ................. 151 Philippe Hantson On Irreversibility as a Prerequisite for Brain Death Determination ................... 161 James L. Bernat How Should Testing for Apnea Be Performed in Diagnosing Brain Death? ......................................................................................... 169 Christoph J. G. Lang and JosefG. Heckmann CONTENTS IX Evoked Potentials in the Diagnosis of Brain Death ........................................... 175 Enrico Facco and Calixto Machado Recovery from Near Death following Cerebral Anoxia: A Case Report Demonstrating Superiority of Median Somatosensory Evoked Potentials over EEG in Predicting a Favorable Outcome after Cardiopulmonary Resuscitation ......................................................................................... 189 Ted L. Rothstein Human Brain-Dead Donors and 31p MRS Studies on Feline Myocardial Energy Metabolism ........................................................... 197 George J. Brandon Bravo Bruinsma and Cees J.A. Van Echteld Organ Donation after Fatal Poisoning: An Update with Recent Literature Data ...................................................................................... 207 Philippe Hantson The ABC ofPVS: Problems of Definition ........................................................ 215 D. Alan Shewrnon Brain Function in the Vegetative State .............................................................. 229 Steven Laureys, Marie-Elisabeth Fayrnonville, Xavier De Tiege, Philippe Peigneux, Jacques Bern~, Gustave Moonen, Serge Goldman, and Pierre Maquet Global Neurodynamics and Deep Brain Stimulation: Appreciating the Perspectives of Place and Process ............................. 239 David I. Pincus Honoring Treatment Preferences near the End of Life: The Oregon Physician Orders for Life Sustaining Treatment (POLST) Program ............................................................... 255 Terri A. Schmidt, Susan E. Hickman, and Susan W. Tolle
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