Organ Donation and “Brain Death”: Do you know what you are signing up for?

If you are an organ donor on your driver’s license do you know what you signed up for? Most people I have talked to were never informed what it means. Their thinking is “hey, if I’m already dead I’d like for others to benefit from my organs”. Most have no idea that vital organs like the heart, full liver and lungs cannot be donated if the donor has died. Vital organs are retrieved from patients that are declared “brain dead”. However, the medical community has recently realized that there are several problems with the concept of “brain death”.

Diagnosis of death by neurological criteria alone is theory, not scientific fact. It is not sufficient to overcome the presumption of life and in fact, hundreds of people who have been declared brain dead have lived to tell about it. Some of them woke up on the operating table. Their cases were explained away as misdiagnoses or a miraculous raising from the dead. However, the real cause is that “brain dead” is not dead. There is overwhelming medical and scientific evidence that the complete and irreversible cessation of all brain activity (in the cerebrum, cerebellum and brain stem) is not proof of death.

There is common misperception that a machine is keeping the body of brain dead people alive. But machines can only do so much. If you hook up machines to a dead body they won’t make the body function. People who have been declared brain go through puberty, fight infections, nourish growing babies, metabolize etc.-all things that are managed by the brain and cannot be done by a machine. Our soul and our bodies are integrated, not just our souls and our brains. When true death occurs, there is a dis-integration of the body and soul. So a person who is declared “brain dead” may be injured, but they are not dead.

For years there was no consistent set of criteria to determine brain death. In 2010 a set of guidelines were issued by the American Academy of Neurology in an attempt to ensure that brain death would be diagnosed the right way every time. But those guidelines were proven wrong when in 2014, the first person who met all the criteria for brand death lived for years and responded to commands in spite of claims that she was dead. Her name was Jahi Mc Math.

Jahi McMath Proved that the a diagnosis of brain death is irreversible. Jahi McMath fulfilled all the criteria in the guidelines for brain death. However, after some time had passed, she no longer fulfilled those criteria because she wasn’t dead.

THE SIGNIFICANCE OF JAHI’S FINDINGS ARE THAT THE CLINICAL CRITERIA FOR DIAGNOSING BRAIN DEATH HAVE BEEN SHOWN TO BE TEMPORARY AND UNRELIABLE.

While “Many in the medical and scientific community maintain that brain-related criteria for death are sufficient to generate moral certitude of death itself. Ongoing medical and scientific evidence contradicts this assumption. Neurological criteria alone are not sufficient to generate moral certitude of death itself, and are absolutely incapable of generating physical certainty that death has occurred.” http://www.truthaboutorgandonation.com/Braindeathnotdeath.html

Here is a news story showing Jahi moving on command, She is not “dead”.

Q: What is the relationship between brain death and organ donation?

A: Vital organs cannot be transplanted if they are retrieved after the donor’s biological death. When the concept “brain death” was developed, it enabled the medical community to remove vital organs for transplantation from people who aren’t biologically or philosophically dead.

Living donors can donate organs like kidneys, portions of a liver or lung, but the process of harvesting vital organs for transplantation kills the donor. The way that medicine has justified that killing is by diagnosing the patient as “brain dead”. However, science has now proven that brain death is not true death. There is currently no certainty in the medical field about a diagnosis of brain death.

Q: Why was the concept of “brain death” introduced?

A: according to the Harvard Commission of 1968. The commission’s intent was to provide a new definition of death, one that clearly expressed their interest in collecting vital organs from brain injured patients

This interest was no longer that of the dying, namely to avoid being declared dead prematurely, but rather that of other people interested in declaring a dying person dead as soon as possible. Two reasons are given in support of this third-party interest: (1) guaranteeing legal immunity for discontinuing life-prolonging measures that would constitute a financial and personal burden for family members and society alike, and (2) collecting vital organs for the purpose of saving the lives of other human beings through transplantation.

-Is Brain Death the Death of a Human Being?

Q: What is the current scientific Thought about brain death?

A: Below are some examples from recent medical and Philisophical literature demonstrating that the concept brain death is not death and should be abandoned:

Journal of Intensive and Critical Care: The Concept Of Brain Death Should be Abandoned:

2016 Journal of Intensive and Critical Care There are self-evident inconsistencies and contradictions inherent in the concept of "brain death" according to which this concept is invalid. It seems unavoidable that the "brain death" concept should be abandoned. -http://criticalcare.imedpub.com/brain-dead-patients-critically-ill-or-dead-a-potential-answer-to-the-problem.pdf “Brain Dead” Patients Critically Ill or Dead? A Potential Answer to the Problem

Harvard Medical School Professor: The Concept of Brain Death is Incoherent in Theory and Confused in Practice:

2004 Dr. Truog, who is an associate professor of anesthesia at Harvard Medical School, echoes Byrne's argument that brain dead patients are not really dead, stating, "there is evidence that many individuals who fulfill all of the tests for brain death do not have the 'permanent cessation of functioning of the entire brain."' The concept of brain death is "incoherent in theory and confused in practice," Truog continues, and so he recommends a return to the traditional definition of death, based on cessation of respiration and circulation rather than neurological criteria.-

Brain Death: At Once “Well-Settled” and “Persistently Unresolved

Brain death-too flawed to endure, too engrained to abandon

New England Journal of Medicine: Brain Death Definition is Unsupportable and Brain Death is Not Death

The arguments about why these patients should be considered dead have never been fully convincing. The definition of brain death requires the complete absence of all functions of the entire brain, yet many of these patients retain essential neurologic function, such as the regulated secretion of hypothalamic hormones.2 Some have argued that these patients are dead because they are permanently unconscious (which is true), but if this is the justification, then patients in a permanent vegetative state, who breathe spontaneously, should also be diagnosed as dead, a characterization that most regard as implausible. Others have claimed that “brain-dead” patients are dead because their brain damage has led to the “permanent cessation of functioning of the organism as a whole.”3 Yet evidence shows that if these patients are supported beyond the acute phase of their illness (which is rarely done), they can survive for many years.4 The uncomfortable conclusion to be drawn from this literature is that although it may be perfectly ethical to remove vital organs for transplantation from patients who satisfy the diagnostic criteria of brain death, the reason it is ethical cannot be that we are convinced they are really dead. The Dead Donor Rule and Transplantation

The Journal of Medicine and Philosophy: Are Brain Dead Individuals Dead? Grounds for Reasonable Doubt

-We have an obligation to treat BD individuals as if they were living human beings.

Q : Did a set of consistent guidelines to determine brain death ever exist?

A: For many years there was no consistency in what criteria needed to be met to declare someone brain dead. There have been hundreds of people who were declared brain dead and completely recovered.

In 2010 a set of guidelines were issued by the American Academy of Neurology in an attempt to ensure that brain death would be diagnosed the right way every time. But those guidelines were proven wrong when in 2014, the first person who met all the criteria for brand death lived for years and responded to commands in spite of claims that she was dead. Her name was Jahi Mc Math.

Jahi McMath Proved that Brain Death Diagnosis is not Irreversible

Jahi McMath fulfilled all the criteria in the guidelines for brain death that were established in 2010. However, after some time had passed, she no longer fulfilled those criteria!

Q: How can brain death be temporary?

A: It can’t. Recovery from a diagnosis of “brain death” has often occurred naturally with time. True death doesn’t heal with time.

A person who is raised from the dead is miracle. A person who recovers from “brain death” doesn’t experience a miraculous resurrection. They experience healing from a traumatic brain injury that was labeled as “brain death”.

Nuerologist, Dr. Alan Shewmon, theorizes that the concept of the “ischemic penumbra” explains why a person can appear to fulfill the criteria for brain death and then later recover. Brain damage from loss of blood flow can be temporary, and brain function potentially recoverable.

But the reversible injury from ischemia, or loss of blood flow, makes it appear as if brain death has actually occurred. I

In fact at the American Academy of Neurology meeting in May, a paper was presented by Dr. Phil Defina et al, who was treating Jahi. They described her recovery to a minimally conscious state of a woman who was formerly diagnosed with brain death by five neurologists!

These recent reports highlight the fact that the brain is a mysterious organ and there is much that we do not know about it. And that Jahi was not dead, but as Shewmon stated, “she is an extremely disabled, but very much alive teenage girl.”

Jahi McMath proves that “brain death” diagnosis is not irreversible

2015 Kennedy Institute of Ethics: Brain Death is Under Attack

Q: Is brain death a legal status?

A: In some states like California it is. In other states, like New Jersey it is not.

A legal status can be fictional. What really matters is whether it is moral.

“Transplantation of unpaired vital organs is legal in most Western countries, including the United States, and in some developing nations like Brazil, but the important question for anyone is: “is it morally permissible to terminate a life to save another?" Pope John Paul II has repeatedly said as recently as February 4, 2003 message to the World Day of the Sick: “It is never licit to kill one human being in order to save another." The Catechism of the Catholic Church clearly states (2296): “It is morally inadmissible directly to bring about the disabling mutilation or death of a human being, even in order to delay the death of other persons.” http://www.truthaboutorgandonation.com/Braindeathnotdeath.html

An article in Neurology Advisor states : It is difficult, and perhaps impossible, to fully reconcile most definitions of biological death with these observations

“Although there is widespread agreement about the legal status of brain death, there are reasons to question whether loss of all clinical functions of the brain is biologically or philosophically equivalent to death.It's tempting to claim that brain death is biologically and philosophically the same as death (BD = D) because the ventilator is the only reason the lungs and heart continue to work. But there are fully conscious patients (e.g. those with severe cervical spinal cord injuries) for whom this same statement is true — and no one would think of calling them dead just because their heart and lungs are working artificially.

The defender of the claim Brain Death = Death also has to deal with some uncomfortable observations about the biological status of the BD patient.

With modern medicine, the BD patient's digestion and excretion, temperature control, wound healing and infection-fighting all continue happily along — even for years — as long as the ventilator is maintained, and meticulous nursing care is provided. There are even cases of pregnant women becoming brain-dead during pregnancy, and then carrying a healthy baby to full term. It is difficult, and perhaps impossible, to fully reconcile most definitions of biological death with these observations.

The controversy about the philosophical and biological status of BD is more complex than this, and it's not possible to do justice to the two sides of the debate here. But the fact that controversy persists, more than 40 years after the concept of brain death was first formally proposed, is enough to suggest that the biological and philosophical status of brain death is at least open to intellectually respectable debate.

http://www.neurologyadvisor.com/general-neurology/determining-brain-death/article/404490/

At the time of Jahi’s diagnosis of brain death, she met all of the accepted criteria for brain death. Yet she later improved. She was not dead.

Q. Is being kept alive by extraordinary means different than brain death?

A: Yes.

Phil Lawler points asks, What’s wrong with this headline?

Brain dead pregnant woman, 21, was kept alive for 123 days…

How can a dead person be alive?

“The unfortunate woman, who had suffered a massive cerebral hemorrhage, was pregnant. Remarkably, she remained pregnant—that is, her body continued to nourish the unborn twins.

Doctors decided to save the nine-week-old embryos after their hearts continued to beat inside their mothers’ womb.

How could unborn children derive sustenance from a dead body? The simple answer: they couldn’t. All of the mother’s vital organs were working. Yes, the organs had artificial help. But life-support systems can only do so much. A ventilator, for example, can push air in and out of lungs, but it cannot exchange oxygen and carbon dioxide; it cannot put oxygen into the blood stream. Living lungs can do that; dead lungs cannot. But the brain was not functioning, you say? That doesn’t make sense, either. Heart and lungs and intestines and glands receive their impulses from the brain. If the brain was dead, how were the other organs functioning?

Now notice something else about this story: If you remove the notion of “brain death” from the account, the confusion vanishes. A pregnant woman was kept alive by extraordinary means until her unborn children were delivered.”

Brain death: a singular misnomer

Q: Why is the concept of brain death a critical issue for Catholics?

A: If the process of removing organs is the cause of death then it is immoral and must be abandoned.

The Catechism is clear: if the process of harvesting organs is the cause of death, then that procedure must be abandoned.

“The principal criteria of respect for the life of the donator must always prevail so that the extraction of organs be performed only in the case of his/her true death. (cf. Compendium of the Catechism of the Catholic Church, n. 476).”

The Catholic Catechism 2296 states: “…it is not morally admissible directly to bring about the disabling mutilation or death of a human being, even in order to delay the death of other persons.”

“Individual vital organs cannot be extracted except ex cadavere, which, more-over, possesses its own dignity that must be respected”

-Pope Benedict XVI on Nov 7, 2008

That means that if a patient is not truly dead then vital organs cannot be extracted.

There is overwhelming medical and scientific evidence that the complete and irreversible cessation of all brain activity (in the cerebrum, cerebellum and brain stem) is not proof of death. The complete cessation of brain activity cannot be adequately assessed. Irreversibility is a prognosis, not a medically observable fact. We now successfully treat many patients who in the recent past were considered hopeless.

It is now patently evident that there is no single so-called neurological criterion commonly held by the international scientific community to determine certain death. Rather, many different sets of neurological criteria are used without global consensus.

A diagnosis of death by neurological criteria alone is theory, not scientific fact. It is not sufficient to overcome the presumption of life.

The termination of one innocent life in pursuit of saving another, as in the case of the transplantation of unpaired vital organs, does not mitigate the evil of taking an innocent human life. Evil may not be done that good might come of it.

A diagnosis of death by neurological criteria alone is theory, not scientific fact. It is not sufficient to overcome the presumption of life.

No law whatsoever ought to attempt to make licit an act that is intrinsically evil. "I repeat once more that a law which violates an innocent person's natural right to life is unjust and, as such, is not valid as a law. For this reason I urgently appeal once more to all political leaders not to pass laws which, by disregarding the dignity of the person, undermine the very fabric of society."

Q: Has the Church addressed the validity of a Brain death diagnosis?

A: Yes. An examination of Brain-Related Criteria for death, at the Pontifical Academy of Sciences in early February 2005 resulted in several conclusions. Among them is that brain death is a theory and not a scientific fact:

A diagnosis of death by neurological criteria alone is theory, not scientific fact. It is not sufficient to overcome the presumption of life.

See Also “Notes from Linacre Quarterly at the End of this Q. and A. discussion. (The Linacre Quarterly is the oldest journal in existence dedicated to medical ethics).

“There Cannot be the Slightest Suspicion of Arbitration and Where Certainty Has Not Been Attained, the Principle of Precaution Must Prevail”.
-Pope Benedict XVI, speaking about the concept of Brain Death

That required certainty has not been attained. There is no current medical consensus on what constitutes brain death. In fact, numerous medical journals have written about the lack of consensus and numerous have said that “brain dead” patients aren’t dead.

Jahi McMath’s case rocked the world of the brain death concept. Jahi was declared dead in California and was issued a death certificate. Her parents were forced to pick her up up at the morgue to transfer her to a hospital in New Jersey because she was considered dead in the state of California.

Once moved to New Jersey, Jahi lived several years and went through puberty and recovered enough to respond to some simple commands.

Jahi’s diagnosis of “brain death” was a legal and a medical fiction. Her case rocked the world because she was the first person who met ALL the international criteria for brain death, yet she wasn’t dead.

Jahi McMath proves that Brain Death is not irreversible

Q: Didn’t Pope John Paul II accept the concept of brain death?

A: No. Some Catholic bioethicists still use the following statement made by Pope John Paul II in a 2000 Papal Allocution to claim that the Catholic Church has accepted the concept of brain death:

"Here it can be said that the criterion adopted in more recent times for ascertaining the fact of death, namely the complete and irreversible cessation of all brain activity, if rigorously applied, does not seem to conflict with the essential elements of a sound anthropology. Therefore a health-worker professionally responsible for ascertaining death can use these criteria in each individual case as the basis for arriving at that degree of assurance in ethical judgement which moral teaching describes as "moral certainty". Pope John Paul II address to the 18th International Congress of Transplantation Society

It is important to note what Pope John Paul II did and did not say. He said that the criterion do not “seem to conflict” with a sound anthropology. He did not say that they don’t conflict. Scientific knowledge has now revealed that the criterion do indeed conflict with essential elements of sound anthropology!

Not Quite Dead: The Case for Caution In the Definition of “Brain Death”

if you remove the notion of “brain death”, vital organ transplant can’t be done because of the dead donor rule. Therein lies the difficulty

1. On the one hand the Church recognizes, consistent with her tradition, that the sanctity of all human life from conception to natural end must absolutely be respected and upheld. On the other hand, a secular society tends to place greater emphasis on the quality of living.

2. The Catholic Church has always opposed the destruction of human life before being born through abortion and she equally condemns the premature ending of the life of an innocent donor in order to extend the life of another through unpaired vital organ transplantation. "It is morally inadmissible directly to bring about the disabling mutilation or death of a human being, even in order to delay the death of other persons." “It is never licit to kill one human being in order to save another.”

A diagnosis of death by neurological criteria alone is theory, not scientific fact. It is not sufficient to overcome the presumption of life.

13. The termination of one innocent life in pursuit of saving another, as in the case of the transplantation of unpaired vital organs, does not mitigate the evil of taking an innocent human life. Evil may not be done that good might come of it.

See more of this Collegial Essay “Brain Death is Not Death”:

Brain Death is Not Death

Science has never reached consensus for the concept of brain death so, as Pope Benedict XVI said, the principle of precaution must prevail. The termination of one innocent life in pursuit of saving another does not mitigate the evil of taking an innocent human life.

Key Notes following article from The Linacre Quarterly 84 (2) 2017, 155–186

The perception of the public at large is that the Catholic Church has formally endorsed this neurological standard of brain death. However, a critical reading of the only magisterial document on this subject, Pope John Paul II’s 2000 address, shows that the pope’s acceptance of the neurological criterion is conditional in that it entails a twofold requirement. It requires that certain medical presuppositions of the neurological standard are fulfilled, and that its philosophical premise coheres with the Church’s teaching on the body-soul union.

This article demonstrates that the medical presuppositions are not fulfilled, and that the doctrine of the brain as the central somatic integrator of the body does not cohere either with the current holistic understanding of the human organism or with the Church’s Thomistic doctrine of the soul as the form of the body.

Pope John Paul II and the neurological standard for the determination of death: A critical analysis of his address to the Transplantation Society

JPII and the Nueurological Standard for the Determination of Death

The patient diagnosed with “brain death” is still alive both philosophically and biologically.

If “brain death” is death simpliciter (Battro et al. 2007, xxi), which means that the soul is no longer in the body, then what is the principle that accounts for the persistence of the many vegetative functions such as assimilation of nutrients, elimination of waste, as well as the fever reaction to infection and gestation of a fetus, among others; and the occurrence of the aforementioned movements?

These operations are the manifestations of two powers (the vegetative and locomotion, respectively), the principle and cause of which can only be the soul (Aquinas 2010, I, q. 77, a. 6; q. 78, a. 1), the substantial form of the body and its first principle of life.

This means then that life is still present in the “brain-dead” patient. It is precisely here that the “brain death” standard is hostile to sound anthropology because it classifies as dead patients who are still alive.

Admittedly, these severely ill and deeply comatose patients may be dying; nevertheless, however close to death a person might be, he or she is still alive and not yet dead.

Several scholars, in particular Truog, have also shown (albeit without invoking Thomistic metaphysics) that the “whole brain death” paradigm “confuses the fact that a person is dying with the claim that he or she is already dead” (Truog and Robinson 2003, 2392), that is, “it mistakes a prognosis with an outcome” (Truog and Fackler 1992, 1707).

As previously mentioned, John Paul II’s acceptance of the neurological standard as a criterion for the determination of death presupposes (and hence requires) that several prerequisites be fulfilled, the most important of which is the soundness of the premise of the brain as the principle of integration. This premise has to be true for the conclusion (the Pope’s acceptance) to follow. Not only have none of the other prerequisites been fulfilled, but this premise has also shown itself to contradict both the physiological reality and sound Christian anthropology.

Furthermore, John Paul II also requested the Pontifical Academy of Sciences to sponsor another conference (the third one) on the same topic of “brain death” which took place on February 3–4, 2005.54 This act alone strongly suggests that, from the perspective of the Magisterium, the “brain-death” issue still remains unsettled.

Pope Benedict XVI, in his address to the participants of the 2008 international congress orga- nized by the Pontifical Academy of Life, made no mention of the neurological criterion but gave the following admonition instead:

Individual organs cannot be extracted except ex cadavere... There cannot be the slightest suspicion of arbitration [arbitrariness] and where certainty has not been attained the principle of precaution must prevail.... The principal criteria of respect for the life of the donator [donor] must always prevail so that the extraction of organs be performed only in the case of his/her true death.55 (Benedict XVI 2008)

TOWARD AN ALTERNATIVE APPROACH FOR POTENTIAL BRAIN-DEAD DONORS

As a corollary of the aforementioned analysis, an important practical question arises: What should be the proper course of action toward patients who are destined to be declared “brain dead”?

The loss of brain function, even if it were to be complete, only indicates that the soul no longer has the brain available as its instrument for the mental functioning of the person.56 The result is a state of very severe mental disability (Shewmon 2009, 230), perhaps close to death, but it is not death.

To equate the death of the patient with the loss of function of one organ amounts to reducing the person to that particular organ alone, in this case, the brain. The patient with severe brain injury destined to be declared “brain dead” is still a human person, and as such, “is deserving of respect and dignity, and at the very least, the right to his or her life”57 especially since:

(1) the patient’s outcome cannot be predicted in the acute phase of severe brain injury, and

2) new therapeutic modalities (e.g., hypothermia) have much improved the outcome of patients with severe brain injury.58

However noble the concept of organ donation is, it cannot justify taking the life of one sick (and dying) person for the sake of saving the lives of several other sick persons.

Human life, even that of the moribund person, is of infinite value because it is a gift of God.

Thus, what we urgently need today is “the restoration of societal respect for the [sacredness] of human life —respect that was somehow lost in the acceptance of whole brain death as ... death of the person” (Diamond 2007, 497).

Since “brain death” cannot be shown to be sound, whether biologically or anthropologically, a more humane approach should be offered to patients with severe brain injury who, instead of being declared “brain dead” within one–two days of admission, should be treated aggressively (with a view to recovery, whether full or partial) and supported through the acute phase of the injury.

Admittedly, not every one of them will survive, but then not every one of them will die either. If the patient steadily deteriorates towards imminent death (a trajectory which the powers of medical technology are unable to change),59 then he or she should be allowed to die naturally. The approach proposed here will also cohere with Pope Pius XII’s admonition, “human life continues for as long as its vital functions ... manifest themselves spontaneously or even with the help of artificial processes” (Pius XII 1957).

In The NewsVictoria ClarkOctober 8, 2019Comment