I recently read an amazing book titled
” by Dick Teresi. In the book, Teresi sheds light on the uncertainty of brain death and how the current definition of brain death may
lead doctors to harvest the organs of people who, in the fullness of time, might recovery completely.
This shocked me. After all, brain dead is the same as dead, right? Turns out that is a very common misconception, and one that medical professionals
still argue over today.
In order to better understand the problem, we need to take a closer look at how we define death. In the past, a patient was declared dead when his
heart stopped beating and the lungs stopped breathing. With the advent of medical technology, doctors have been able to postpone the moment of death
by keeping patients on life support. Patients may survive a traumatic injury for years on life support, although they may never regain consciousness
(or what we define as consciousness…more later).
In 1968, a Harvard Committee
defined brain death as the following:
• Patient displays no response to pain or cranial nerve reflexes
• Patient has fixed pupils
• Patient has no vestibulo-ocular reflex (Normally, when you tilt a person’s head to the side, the eyes will move. Patients who have brain damage
in a certain area will have what is known as doll’s eyes; the eyes do not move when the head is turned side to side. Instead, the eyes stare
straight ahead, like a doll’s)
• Patient has no corneal reflex (touching the exposed eye with a swab or finger should cause the person to blink)
• Patient does not respond to caloric reflex test (squirting ice-cold water into the ear)
• Patient does not breathe spontaneously on his own
The interesting thing to note is that the above requirements all have to do with the functioning of the brain stem. However, they do not indicate
whether the rest of the brain is working.
Before we go any further, let’s review the functions of the different parts of the
. This is a very basic breakdown, and I’m only discussing the brain stem
and the cortex, because these systems have the most bearing on brain death.
The brain stem is responsible for basic vital life functions such as breathing, heartbeat, and blood pressure. Scientists say that this is the
"simplest" part of human brains because animals' entire brains, such as reptiles (who appear early on the evolutionary scale) resemble our brain
Without a functioning brain stem, it is impossible to maintain life (except on life support). This is why the Harvard Criteria for
Brain Death focuses solely on the brain stem. But let’s hold that thought for a moment, and review the cortex.
The cerebrum or cortex is the largest part of the human brain, associated with higher brain function such as thought and action. The
cerebral cortex is divided into four sections, called "lobes": the frontal lobe, parietal lobe, occipital lobe, and temporal lobe. What do each of
these lobes do?
Frontal Lobe- associated with reasoning, planning, parts of speech, movement, emotions, and problem solving
Parietal Lobe- associated with movement, orientation, recognition, perception of stimuli
Occipital Lobe- associated with visual processing
Temporal Lobe- associated with perception and recognition of auditory stimuli, memory, and speech
Now, here’s what has many people questioning the legitimacy of declaring someone brain dead. We assume that if someone has a non-functioning brain
stem, that the rest of the brain must also be destroyed. This is not necessarily the case. In fact, there are reports of people declared “brain
dead” who are conscious the entire time; they feel pain, experience thirst, and are completely unable to communicate with the world around them.
Why? Because, although their brain stem is incapacitated, the higher centers of their brain still work.
But don’t take my word for it. Let’s take a look at some cases of “mistaken” diagnosis….folks who were declared brain dead but were really
suffering from different conditions.
From The New England Journal of Medicine
Misdiagnosis of brain death is possible if a locked-in
syndrome, hypothermia, or drug intoxication is not recognized. The locked-in syndrome is usually a consequence of the destruction of the base of the
pons. The patient cannot move the limbs, grimace, or swallow, but the upper rostral mesencephalic structuresinvolved in voluntary blinking and
vertical eye movements remain intact. Consciousness persists because the tegmentum, with the reticular formation, is not affected. The condition is
most often caused by an acute embolus to the basilar artery. More dramatic is the reversible Guillain–Barré syndrome involving all the peripheral
and cranial nerves. The progression occurs over a period of days, and knowledge of the history should prevent the dangerous error of diagnosing brain
Accidental hypothermia from prolonged environmental exposure may mimic loss of brain function, but alcohol intoxication and head injury are
often major confounders. Hypothermia causes a downward spiral of loss of brain-stem reflexes and pupillary dilatation. The response to light is lost
at core temperatures of 28°C to 32°C, and brain-stem reflexes disappear when the core temperature drops below 28°C.These deficits are all
potentially reversible, even after extreme hypothermia.
Want a specific example? Consider the case of
“The schoolboy was travelling in a Rover with two friends in February 2008 when a stray horse ran into the path of the car in front of them.
Steven suffered serious injuries to his face, head and arm, and was declared brain dead two days later. He said: ‘The doctors were telling my
parents that they wanted to take me off the life support. The words they used to my parents were “You need to start thinking about organ
donations”. Accountant Mr Thorpe, 51, contacted private GP Julia Piper, known for her work in traditional and alternative medicines. Moved by their
story, she asked a neurosurgeon whom she knew to visit Steven at University Hospital in Coventry. Incredibly, he concluded that Steven was not brain
dead and that there was still a slim chance of recovery. Doctors agreed to try to bring Steven out of his chemically-induced coma to see if he could
survive. Two weeks later, he woke up.He said: ‘It’s very worrying to think that more than one specialist had written me off.”
, this time the young
man actually heard the doctors pronounce him brain dead.
So how many misdiagnosis of brain death occurs each year? Although I searched I found no hard evidence or statistics that would indicate the rate of
misdiagnosis, probably because the only way to recognize that someone was wrongly diagnosed is if they recover.
So, now that we know that some brain dead patients are, in fact, alive and conscious….how does that tie in with an organ donation conspiracy?
Well, lets take a closer look at the organ donation industry. Who benefits financially from organ donation? Not the patient who receives the organ,
nor the patient’s family who donates the organ. So who’s making the money? The transplant team. And they only get paid if a “harvest” and
transplant takes place.
Now, I don’t mean to imply that transplant surgeons are greedy, unethical doctors who are eager to declare everyone brain dead just so they can make
money. But is it possible that SOME doctors would encourage a diagnosis of brain death more quickly if the family is willing to donate organs?
Perhaps they are so eager to save another person’s life that they regard the donor as simply a
“beating heart cadaver
According to Dick Teresi, that answer is a probable yes. He contends that some doctors will hastily declare brain death either out of willful neglect
or simple incompetence.
Obviously, organ donation saves lives and I don’t want to discourage anyone from donating your organs. I’m an organ donor, but after reading this
book and doing my research, I’ve left some specific instructions for my family to make sure my “brain death” is not misdiagnosed. These
preventive measures include disconnection from life support for a minimum of 5 minutes (the current standard is 2 minutes) to make sure I do not take
voluntary breaths. I also want a brain scan that checks the cortex for activity, not just the brain stem.
There is a lot of information I did not include in this op, but are fascinating nevertheless. I highly recommend reading the book if you are
edit on 18-9-2012 by smyleegrl because: (no reason given)