"Brain death"
A lie destined to die


1. Maternal brain death; brain dead pregnant women who were deliberately kept alive until their babies were ripe enough to be delivered. The mothers were sacrificed thereafter.


2. Case records of brain dead patients who regained their consciousness after being formally pronounced brain dead. The reports came from: USA, UK and Saudi Arabia.


3. The Lazarus sign (L.S.): spontaneous, complex purposeful movements of the limbs and the trunk in the so called "brain dead" patients who cough and try to breathe during apnea testing.


4. Chronic brain death: some studies done by the American academy of neurologists and others which prove that some brain dead patients survived for periods exceeding 14 years.


1. Maternal brain death

As the year 1968 witnessed the 1st ­ world wide legal recognition of brain death by the declaration of the Harvard criteria defining it, the year 1982(1) witnessed the 1st heavy blow received by the proponents of this concept. This blow was a case report that appeared in the JAMA declaring the successful attempt made by the authors to sustain (or prolong) the life of a pregnant brain dead mother for a few weeks until she delivered a healthy baby. This was described at that time as "the straw that broke the camel's back". More research continued in the years to come until in 1988(2) another report appeared in JAMA emphasizing the capability of brain dead pregnant women to give birth to healthy babies. Ever since then, many other case reports have appeared in the literature that it became a well recognized "fact" known under the heading of maternal brain death. It is to be noted that a single study reported in the journal of critical care medicine in 2003(3) involved 11 cases, 10 to whom continued their pregnancy and gave birth to normal healthy babies. The next three films show three cases of brain dead mothers that have been kept alive on advanced life support for several weeks until their babies were mature enough to be delivered. The mothers were sacrificed afterwards .




Crit Care Med. 2003 Apr; 31(4):1241-9.

Extended somatic support for pregnant women after brain death.

Powner DJ, Bernstein IM.

Department of Neurosurgery, University of Texas, Houston, TX, USA.

OBJECTIVE: To review case reports of pregnant women who have been supported after brain death until successful delivery of their infants. From these reports and other literature about brain death, normal physiologic changes of pregnancy, and specific needs for fetal development, recommendations were made to assist in supporting pregnant women after brain death until delivery of a mature fetus who is likely to survive.

DATA SOURCES: Personal files and experiences, MEDLINE review of case reports and publications about physiologic changes present during normal pregnancy and after brain death, and the critical needs for fetal development were included. DATA EXTRACTION: Eleven reports of ten patients comprise the accumulated clinical experience. Hypotension, requiring fluid administration and inotropic/vasopressor therapy, occurred in all the mothers, and in six cases, was the reason for urgent delivery. The longest period of support was 107 days, from 15 to 32 wks of gestation. Two mothers also became organ donors. Recurrent infections, thermolability, and other complications common to prolonged ICU care were encountered. All infants survived. One had congenital abnormalities caused by phenytoin use by the mother. When followed, all others developed within normal growth and mental variables. These cases plus literature citations noted above were used to develop recommendations for maternal/fetal care.
Preservation of uterine/placental blood flow is the most important priority during somatic support. Imprecise autoregulation of the uterine vasculature during maternal hypoxemia or hypotension makes this goal a significant challenge. Special considerations for nutrition; medication use; cardiovascular, respiratory, or endocrine therapy; fetal monitoring; hormone replacement; and ethical concerns are discussed.


Reprod Health. 2006 Apr 27; 3:3.

The prolongation of somatic support in a pregnant woman with brain-death: a case report

Souza JP, Oliveira-Neto A, Surita FG, Cecatti JG, Amaral E, Pinto e Silva JL. 

Intensive Care Unit, Department of Obstetrics and Gynecology, School of Medical Sciences, State University of Campinas, Campinas, São Paulo, Brazil. souzajpd@unicamp.br

BACKGROUND: Medical literature has increasingly reported cases of maternal brain death during pregnancy. This is a rare situation which demands the decision and, depending on the gestational age, the implementation of a set of measures to prolong the homeostasis of the human body after brain death for the purpose of maintaining the foetus alive until its viability. CASE PRESENTATION: A 40 year old woman suffered an intracranial haemorrhage during the 25th week of pregnancy. Despite neurosurgical drainage of a gross intraparenchymatous haematoma, the patient developed brain death. Upon confirmation of this diagnosis, she received full ventilatory and nutritional support, vasoactive drugs, maintenance of normothermia, hormone replacement and other supportive measures required to prolong gestation and improve the survival prognosis of her foetus. All decisions regarding the patient's treatment were taken in consensus with her family. She also received corticosteroids to accelerate foetal lung maturity. During the twenty-five days of somatic support, the woman's condition remained stable; however, during the last seven days the foetus developed oligohydramnios and brain-sparring, which led the medical team to take the decision to perform a Caesarean section at that moment. After delivery, the patient's organs were removed for donation. The male infant was born weighing 815 g, with an Apgar score of 9 and 10 at the first and fifth minutes, respectively. The infant was admitted to the neonatal intensive care unit, but did not require mechanical ventilation and had no major complications. He was discharged at 40 days of life, with no sequelae and weighing 1850 g. CONCLUSION: These results are in accordance with findings from previous studies and case reports suggesting the appropriateness and safety of extended somatic support during pregnancy under certain circumstances. They also suggest the need for prompt diagnosis of brain death before the occurrence of physiological degeneration, rapid evaluation of foetal status and the decision of the family together with the medical team to prolong maternal somatic support. The occurrence of maternal brain death is a tragedy, but it may also represent a challenging opportunity to save the life of the foetus and, in addition, permit donation of the maternal organs.


Obstet Gynecol Surv. 2000 Nov; 55(11):708-14

Irreversible maternal brain injury during pregnancy: a case report and review of the literature

Feldman DM, Borgida AF, Rodis JF, Campbell WA.

Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington 06030-2950, USA. dfeldman@nso2.uchc.edu

Maternal brain death or massive injury leading to persistent vegetative state during pregnancy is a rare event. Since 1979, 11 cases, including the current one, of irreversible maternal brain damage in pregnancy have been reported. In all but one, the pregnancies were prolonged with a goal of achieving delivery of a viable infant. Current advances in medicine and critical care enable today's physician to offer prolonged life-support to maximize the chances for survival in the neonate whose mother is technically brain dead. We present a case at our institution and review all previously published cases in the English literature for comparison as well as make management recommendations.

 Journal of the American Medical Association

JAMA. 1988 Aug 12; 260(6):816-22.

Maternal brain death during pregnancy. Medical and ethical issues.

Field DR, Gates EA, Creasy RK, Jonsen AR, Laros RK Jr.

Department of Obstetrics, Gynecology, University of California, San Francisco 94143-0132.

We present in detail a case of a 27-year-old primigravida who was maintained in a brain-dead state for nine weeks. An apparently normal and healthy male infant weighing 1440 g was delivered. The newborn did well and was found to be growing and developing normally at 18 months of age. Although the technical aspects of prolonged life support are demanding and the economic costs are very high (+217,784), there are ample ethical arguments justifying the separation of brain death and somatic death and the maintenance of the brain-dead mother so that her unborn fetus can develop and mature.

KIE: Physicians and an ethicist at the University of California, San Francisco, present the details of the case of a pregnant, brain-dead woman whose vital functions were maintained for nine weeks until the delivery of a healthy infant at 31 weeks' gestation. Despite the technical difficulties involved and the economic costs incurred ($183,031 for maternal care and $34,703 for neonatal care), the authors conclude that ethical considerations support the decision on care. They argue that the woman was not injured; that nonmaleficence and beneficence toward the fetus require a rescue attempt if there is a reasonable chance of reaching fetal maturity; that maternal medical care may be more cost effective than prolonged neonatal support; and that the father's wishes were respected. Rather than proposing guidelines, they hold that decisions on prolonged maternal support should be based on the circumstances of each case.


Journal of the American Medical Association

JAMA. 1982 Sep 3; 248(9):1089-91

Life support and maternal death during pregnancy

Dillon WP, Lee RV, Tronolone MJ, Buckwald S, Foote RJ.

KIE: The authors are physicians affiliated with the State University of New York at Buffalo and the Children's Hospital of Buffalo. They describe the clinical management of two brain-dead pregnant women and suggest guidelines to help physicians decide whether to treat such women. Based on the dramatically increasing chances for fetal survival from the 24th to the 27th weeks of gestation, they recommend vigorous life support during this period to permit fetal viability and prognosis to be assessed. Fetuses of 28 weeks should be delivered by cesarean section as soon as practicable after confirmation of maternal brain death.


Promoting thoughtful, balanced reflection on the ethical and social issues of medicine and medical science

Hastings Cent Rep. 1986 Feb; 16(1):12-7

On dying more than one deathShrader D


Death (with a capital D) can best be understood as a series of distinct but related deaths. For example, a pregnant woman was found to be brain-dead but her vital functions were artificially sustained for nine weeks until her fetus could be delivered, after which the machines were removed and she died a second, conceptually distinct death. This procedure is probably justifiable, but any legislation or policy regarding such cases should be flexible and should require consent.

KIE: It is argued that death should be understood as encompassing a series of distinct but related events. Human beings are viewed as a composite of two intimately related but distinguishable components, as both persons and biological entities. Thus, a brain dead patient can be considered in some sense alive and in some sense dead. This thesis forms the basis for an analysis of a case in which a brain dead pregnant woman's vital functions were artificially sustained until her fetus could be delivered alive, after which the woman's life support systems were disconnected and she ceased breathing. The author holds that this procedure was morally justifiable. He suggests that a multiple-deaths analysis may provide a general framework for discussion of the conditions that justify maintenance of biological functions in neocortically dead human beings, but cautions that any legislation or policy regarding such cases should be flexible and should require consent.



Revista médica de Chile

Rev Med Chil. 1998 Apr; 126(4):450-5.

Maternal brain death during pregnancy

[Article in Spanish]

Beca JP, Wells W, Rubio W.

Facultad de Medicina, Universidad de Chile.

The case of a pregnant patient who had a massive intracraneal haemorrhage at 18 weeks of gestation is presented. Patient's neurological damage evolved to brain death, but the fetus continued in good condition. The decision of withdrawing life support or to continue supporting the mother's life to allow fetal development aroused difficult ethical questions, both to relatives and professionals. This is an exceptional situation of a heart beating cadaver and a non viable fetus whose life depends on the continuation of treatments that are considered as experimental. A good decision should be based on the respect to a body in brain death, the fetal right to life, family's wishes and values, the use of experimental treatments, and the rational use of a public hospital's resources. The conclusion was that the continuation of life support treatments was not an ethical obligation. Withdrawing life support to allow fetal death in this case means foregoing an experimental treatment and to respect family's autonomy and the right of the patient's death with dignity. Similar cases need to be discussed with a multidisciplinary analysis in their own particularity.



Critical Care Clinics

Crit Care Clin. 2004 Oct;20(4):747-61

Cardiopulmonary resuscitation and somatic support of the pregnant patient.

Mallampalli A, Powner DJ, Gardner MO.

Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Ben Taub General Hospital, 1504 Taub Loop, 6th Floor, Houston, TX 77030, USA. antara@bcm.tmc.edu

Cardiopulmonary arrest during pregnancy is a rare event that critical care clinicians must be prepared to manage. The causes of cardiopulmonary arrest during pregnancy, recommended modifications to cardiopulmonary resuscitation protocols that are specific to pregnancy, indications for and timing of perimortem cesarean delivery, and the expected fetal outcomes are reviewed. Rarely, brain death of a pregnant patient may occur in which continued support of the mother is possible to prolong the pregnancy and improve fetal outcome. Prolonged somatic support of pregnant patients who are brain dead presents specific management challenges, but has been accomplished. The physiologic changes that occur after brain death and recommendations for somatic support of the brain dead pregnant patient also are reviewed.

Crit Care Med. 2005 Oct; 33(10 Suppl):S325-31.

Cardiac arrest in pregnancy and somatic support after brain death.

Mallampalli A, Guy E.

Section of Pulmonary and Critical Care Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.

OBJECTIVE: To review the important causes of cardiopulmonary arrest during pregnancy and the recommended modifications to resuscitation protocols when applied to pregnant patients, including the indications for perimortem cesarean section and the expected fetal outcomes, and to review the literature regarding extended somatic support after brain death during pregnancy. DATA SOURCES: MEDLINE review of publications relating to cardiac arrest and resuscitation in pregnancy, physiologic changes after brain death, and attempted somatic support of brain-dead pregnant women. CONCLUSIONS: Cardiac arrest during pregnancy is rare, but it is important to recognize the causes, which may be either unrelated to pregnancy or unique to the pregnant woman. For the most part, the resuscitation protocol is the same as for nonpregnant victims of cardiac arrest, with a few important modifications, including especially the need for relieving aortocaval compression by the gravid uterus, the need for rapid intubation, and the importance of rapid perimortem cesarean delivery when indicated. In those rare cases of brain death occurring in a pregnant patient, continued somatic support of the mother may be possible, even for prolonged periods, to extend the pregnancy and further fetal maturation. The expected physiologic changes after brain death, challenges to successful somatic support, and specific recommendations regarding organ support of the brain-dead pregnant woman are reviewed.


Neurocritical Care

Neurocrit Care. 2005;3(2):99-106

Maternal brain death and somatic support.

Farragher RA, Laffey JG.

Department of Anesthesia, University College Hospital, and Clinical Sciences Institute, National University of Ireland, Galway, Ireland.

Brain death is a concept used in situations in which life-support equipment obscures the conventional cardiopulmonary criteria of death, and it is legally recognized in most countries worldwide. Brain death during pregnancy is an occasional and tragic occurrence. The mother and fetus are two distinct organisms, and the death of the mother mandates consideration of the well-being of the fetus. Where maternal brain death occurs after the onset of fetal viability, the benefits of prolonging the pregnancy to allow further fetal maturation must be weighed against the risks of continued time in utero, and preparations must be made to facilitate urgent cesarean section and fetal resuscitation at short notice. Where the fetus is nonviable, one must consider whether continuation of maternal organ supportive measures in an attempt to attain fetal viability is appropriate, or whether it constitutes futile care. Although the gestational age of the fetus is central to resolving this issue, there is no clear upper physiological limit to the prolongation of somatic function after brain death. Furthermore, medical experience regarding prolonged somatic support is limited and can be considered experimental therapy. This article explores these issues by considering the concept of brain death and how it relates to somatic death. The current limits of fetal viability are then discussed. The complex ethical issues and the important variations in the legal context worldwide are considered. Finally, the likelihood of successfully sustaining maternal somatic function for prolonged periods and the medical and obstetric issues that are likely to arise are examined.

Journal of transplant coordination

J Transpl Coord. 1997 Sep;7(3):103-5.

Dead Organ recovery following childbirth by a brain-mother: a case report.

Lewis DD, Vidovich RR.

Ohio Valley Life Center, Cincinnati, USA.

Little information is available in the medical and nursing literature concerning organ recovery from brain-dead, pregnant individuals. Many healthcare professionals might rule out such patients as potential donors, especially if childbirth is a possibility. This article presents an actual case study in which the birth of a healthy infant and recovery of organs from the mother were successful. It also reviews the available literature and discusses factors related to organ placement.

Journal of Obstetrics and Gynaecology

Obstet Gynecol. 1989 Sep;74(3 Pt 2):434-7.

Maternal brain death and prolonged fetal survival.

Bernstein IM, Watson M, Simmons GM, Catalano PM, Davis G, Collins R.

Department of Obstetrics and Gynecology, Medical Center Hospital, Vermont, Burlington.

A 30-year-old woman suffered massive brain injuries after a motor vehicle accident at 15 weeks' gestation. The patient was diagnosed as brain-dead on her tenth hospital day. She was supported with intensive care for 107 days after this diagnosis and a normal 1555-g male infant was delivered at approximately 32 weeks' gestation by repeat cesarean section. The child is developing normally at 11 months of age. This represents the longest reported case of prolongation of pregnancy after brain death

Minerva Anestesiologica

A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Minerva Anestesiol. 1992 Nov; 58(11):1247-52.

Brain death and prolonged fetal survival [Article in Italian]

Antonini C, Alleva S, Campailla MT, Pelosi G, Valle E, Verrua M, Zamponi E, Blanda A, Gambaro C.

Facoltà di Medicina e Chirurgia, Università degli Studi di Torino.

The Authors presents in detail a case of a 25-year-old primigravida that had fatal intracranial bleeding at the beginning of the 15th week of gestation, whose vital function are sustained for 49 days. Despite the insuccess to bring the pregnancy to a gestational period favorable to induce the delivery, they analyze the problems connected to the maternal maintenance and to the fetal growth.



2. Some documented cases of the so called "brain death", who regained their consciousness in the USA, Britain and, Saudi Arabia


 It is to be noted that all cases mentioned in this text were formally declared brain dead by a "three doctor committee" in recognized centres and according to the protocols adopted by these centres. The families of these patients were asked for consent for organ donation of their "deceased" ones. In some of these cases the families agreed and preparations for organ harvesting were made while in others the consent was denied and the families insisted on continuing medical treatment. However all cases recovered (check the details). It is worth mentioning that cases of brain death that regain consciousness are deliberately ignored and hardly ever referred to in public because of legal implications and liabilities. The information usually leaks through the families to the media and hence become recorded and published. This explains the reason for the scarcity of the number of such cases that get exposed in public in spite of being so plenty. This fact has recently been emphasized by an Egyptian urosugeon (Dr. Hossam El-Din Mostafa, ex-president of the Canadian society of urosurgeons, Ontario, Canada, and fellow of royal college of surgeons in London) in El-Ahram newspaper on 9/2/2008. Dr. Hossam mentioned a personal story that took place when he was an assistant of a leading surgeon in one of the leading industrial countries. After the kidneys had been harvested in a brain dead patient and at the end of the procedure, the patient showed signs of life. The surgeon asked Dr. Hossam to keep the secret to himself as the patient's family might press charges (refer to the article).


Even though transplant surgeons are always in a hurry to harvest organs from patients as soon as they are declared brain dead (after six hours and up to 24 hours at most according to the protocol used) and by so doing they hardly give such patients any real chance to recover. And inspite of the fact that transplant surgeons are so discrete and are always so strict in addressing the media trying to hide information concerning those cases that recover after being diagnosed brain dead. Inspite of all that some information concerning such cases manages to find its way to the media or to scientific journals. And we are disclosing here in some of the documented cases that have been officially declared or pronounced brain dead and yet recovered and were hence published whether in scientific journals or in the different media.


Case 1

LifeSiteNews.com Friday February 15, 2008

Woman Diagnosed as "Brain Dead" Walks and Talks after Awakening  By Hilary White
LAKE ELMO, Minnesota, February 15, 2008 (LifeSiteNews.com) - 65-year-old Raleane "Rae" Kupferschmidt's relatives were told by doctors that she was "brain dead" after she had suffered a massive cerebral haemorrhage in mid-January, according to an Associated Press Report. Her family had taken her home to die and was in the process of grieving and planning her funeral when she awoke and was rushed back to hospital.  In accordance with her own wishes, doctors had removed Rae's breathing tube and were waiting for her to die. She was taken home from the hospital, and while friends and family gathered to say a last good bye, Kupferschmidt's daughter Lisa Sturm used an ice cube to wet her mother's dry lips. When her mother sucked on the ice cube, she thought it was only an instinctive reaction. She said, "I knew suckling is a very basic brain stem function, so I didn't get real excited. But when I did it again she just about sucked the ice cube out of my hand, and I looked at my aunt and said, 'Did you see that?'" "So I leaned down and asked, 'Mom... Mom, are you in there?'" Sturm said. "And when she shook her head and mouthed, 'Yes,' we all just about fell over." Rae was rushed back to the hospital and underwent surgery to drain the blood clot from her skull. After surgery, she recovered her strength and is now undergoing physical therapy and can walk with the aid of a walker. Doctors expect her to be walking on her own within weeks. Rae says she does not remember anything during her coma. "I still don't know what my task is here on this Earth, but I know God's not done with me yet. How else could you explain everything that has happened to me?" Rae said. She told family that she had seen angels in her room. "I said these angels are not here to take me home to my father. They're here to help me, to help me get over this. "Brain death" or "death by neurological criteria," is common media terminology for patients who are said to be in an irreversible coma, sometimes referred to as a "persistent vegetative state" (PVS) Physicians and bioethicists who support "brain death" criteria claim that such a diagnosis is reliable and means that a patient is beyond any hope of recovery.  Under new bioethics criteria, "brain death" can be used as a condition under which organs are removed from a patient while his heart is kept beating. Organ transplant requires that tissue be recovered from donors as close to physical death as possible and physicians are under heavy pressure to procure more organs. The fact that in some cases patients who have been unconscious, semi-conscious or severely neurologically disabled have been declared "brain dead" or "PVS" only to recover has undermined public confidence in the medical system. In the US in 2006, Terry Wallis, who experienced a car wreck in 1984, woke unexpectedly and began to recover after 19 years in a minimally conscious state. In 2005 in Italy, Salvatore Crisafulli woke from a coma he had suffered for two years. He had been declared "nearly dead" by doctors after a serious auto accident that left him unresponsive. In Poland in 2007, a railway worker astonished his family and doctors when he awoke spontaneously after 19 years. Doctors at United Hospital said they are amazed by Rae Kupferschmidt's recovery. One told Good Morning America, "I've been here for ten years and I've never seen anything quite like this."
Rae told Good Morning America, "God's got something for me to do. When I learn it, I'll unfold it and follow it."


Case 2

 Mon March 24, 2008

Man declared dead, says he feels 'pretty good'

This photo provided by the NBC Today television program shows Doug Dunlap, left, and his son Zach Dunlap, during their interview with Today show correspondent Natalie Morales.

 This photo provided by the NBC Today television program shows Doug Dunlap, left, and his son Zach Dunlap, during their interview with Today show correspondent Natalie Morales.24.3.2008


Story Highlights

Family members were paying last respects when Dunlap moved hand and foot

He remembers hearing doctors pronounce him dead

Father says brain scan showed no activity

Mother says it was a miraculous feeling to discover son still alive

OKLAHOMA CITY, Oklahoma (AP) -- Zach Dunlap says he feels "pretty good," four months after he was declared brain dead and doctors were about to remove his organs for transplant.


Zach Dunlap, 21, said he has no recollection of his crash.

Dunlap was pronounced dead November 19 at United Regional Healthcare System in Wichita Falls, Texas, after he was injured in an all-terrain vehicle accident. His family approved having his organs harvested.

As family members were paying their last respects, he moved his foot and hand. He reacted to a pocketknife scraped across his foot and to pressure applied under a fingernail. After 48 days in the hospital, he was allowed to return home, where he continues to work on his recovery.

On Monday, he and his family were in New York, appearing on NBC's "Today."

"I feel pretty good. but it's just hard ... just ain't got the patience," Dunlap told NBC.

Dunlap, 21, of Frederick, Oklahoma, said he has no recollection of the crash.

"I remember a little bit that was about an hour before the accident happened. But then about six hours before that, I remember," he said.

Dunlap said one thing he does remember is hearing the doctors pronounce him dead.

"I'm glad I couldn't get up and do what I wanted to do," he said.

Asked if he would have wanted to get up and shake them and say he's alive, Dunlap responded: "Probably would have been a broken window that went out."

His father, Doug, said he saw the results of the brain scan.

"There was no activity at all, no blood flow at all."

Zach's mother, Pam, said that when she discovered he was still alive, "That was the most miraculous feeling."

"We had gone, like I said, from the lowest possible emotion that a parent could feel to the top of the mountains again," she said.

She said her son is doing "amazingly well," but still has problems with his memory as his brain heals from the traumatic injury.

"It may take a year or more ... before he completely recovers," she said. "But that's OK. It doesn't matter how long it takes. We're just all so thankful and blessed that we have him here."

Dunlap now has the pocketknife that was scraped across his foot, causing the first reaction.

"Just makes me thankful, makes me thankful that they didn't give up," he said. "Only the good die young, so I didn't go."

Case 3


The Middle East's Leading English Language Daily Monday 5 November 2007 (25 Shawwal 1428)

Woman Declared Brain Dead Now Starts to Speak
Muhammad Al-Homaid, Arab News

YANBU, 5 November 2007 — The Yanbu General Hospital yesterday announced a change in the condition of Fatima Rifaie, a 33-year-old Saudi woman who was declared brain dead following a medical error three months ago.

“My sister’s condition has improved considerably. She has begun recognizing and talking to relatives who come to visit her,” Eid Rifaie, Fatima's brother, told Arab News yesterday. However, Eid added that it would take months before his sister returned to normalcy.

Fatima, who was a chronic asthma patient, went into a coma after she was allegedly administered a banned antibiotic on Aug. 3. The doctor who administered the injection, allegedly a Syrian, has been suspended.

Dr. Yaser Redwan, a heart consultant at Erfan and Saiedi General Hospital in Yanbu, later examined Fatima and said she was brain dead and that her heart had stopped as a result of the injection. He said that the delay in treating her after her condition worsened had resulted in brain atrophy that later left her brain dead. Redwan blamed the doctor for Fatima's condition and said he had not tested to see whether the patient was allergic to the antibiotic.

Fatima was later transferred to King Fahd Hospital in Madinah. On Aug. 27, doctors reported that she was not brain dead but that she was in a coma. After an emergency surgery to revive her in Madinah, she was sent back to the Yanbu hospital to continue treatment.

Case 4



 Asharq Alawsat Newspaper


LOS ANGELES (Reuters) -Doctors pronounced Ethan Myers brain dead after a car accident dealt the 9-year-old a severe brain injury in 2002. After he miraculously awoke from a nearly month-long coma, doctors declared he would never again eat on his own, walk or talk.

Yet, thanks partly to a video game system, Myers has caught up with his peers in school and even read a speech to a large group of students.

"I'm doing the exact same things as them. I'm getting buddies and stuff," said Myers, who had relearned to walk and was reading at a second-grade level before his video game therapy began in May 2004.

"I couldn't remember where I put stuff and now I can. I remember school stuff and people's names," he said in a telephone interview from his family's home in Colorado.

More fundamentally, Myers can now fully open his right hand, which paralysis had curled closed. His brother and sister, who were in the car with him during the accident and each suffered mild brain injuries, have also shown improvement in their memory and other functions.

Ethan and his parents attribute his most recent progress to neuro-feedback training on the Cyber Learning Technology LLC system, which is often used to play car racing video games. "In the last year, we've seen the Ethan we knew before the accident," said Howard Myers, the teenager's father.

Case 5


DYING TO LIVE Defining death

Question of brain death can complicate the ethics of organ donation

Monday, November 15, 2004 by DAVE PARKS

News staff writer

The Florida woman was pronounced brain dead at UAB Hospital after suffering severe bleeding inside her head. Her family gave doctors permission to remove vital organs for transplant.  It was around midnight, and surgeries — for the donor and recipients — were scheduled the next morning, Sunday, Oct. 31. Meanwhile, the donor's body was kept on a ventilator and given drugs to maintain blood flow, all steps necessary to maintain organs for transplant. Then everybody waited. But the unexpected occurred. During the night, somebody in the intensive care unit saw the ventilator's light pop on, an indication the woman was breathing on her own and wasn't brain dead. An electroencephalogram, or EEG, picked up what appeared to be electric signals in her brain. The organ procurement was canceled, and everybody waited some more. Dr. Steve Bynon, a transplant surgeon at the University of Alabama at Birmingham, said the incident was unusual, but it showed that medical safeguards work. Organs are not taken from donors whose brains are still alive. "We just aren't an organ mill."


Case 6




Christina after the announcement of the pretended diagnosis of brain death

Christina after the awakening


  On July 15, 2004, Christina Nichole went into a coma following one-time hypoglycemic episode. All of her organs went into failure and they told us that her brain was gravely deprived of oxygen. She was put on full life-support and declared globally brain damaged and brain dead except for a tiny spotty portion of the bottom of her brain stem. She developed Adult Respiratory Distress Syndrome (ARDS), pneumonia, blood sepsis, Staph, and other life-threatening infections. Her prognosis was "NIL chance of recovery". On the sixth day her father and I were asked to allow them to turn off her life support machines. By this time she had somehow overcome the organ failures, ARDS, pneumonia, sepsis, and infections so we also had to consider organ donation from our 32 year old daughter's body. Her doctors told us that if we did not allow her to be 'let go' (killed from reduction/withdrawal of life support care) we would destine her to live the rest of her life in a persistent vegetative state with no 'quality of life'. Christina had responded to me for the first time that same morning by blinking her eyes ever so slightly on my command, so we did not believe their objective tests. We requested absolute proof of their diagnosis and prognosis with testing that we felt was the minimum of routine procedures in cases like this, an EEG, CAT scan, and MRI. Our requests were flatly denied on the grounds that no further testing was warranted because her doctors 'already knew' what the tests would show them; that she was 'gone' and would never come back. They were wrong! We learned two years later that they had actually performed a CAT scan that showed NORMAL results. Why did they refuse to tell us about the test and why did they continue to insist that we sign the euthanization papers, always telling us she was already dead? They LIED to us, over and over again, in masse. They were angry with us but we stood our ground... praise God! Judy



Case 7

Is a miracle to Life teen who was once 'brain dead'

Deseret News (Salt Lake City), May 21, 2005  by Sara Israelsen Deseret Morning News

PROVO -- When Derek Maughan goes to get a burger, it's a big deal. Cruising to a local fast-food place may not seem like much to other 17-year-olds, but for this survivor it seems like a miracle. When he was 2 months old, Derek's skull was shattered in a car accident. Doctors declared him to be brain dead. However, the little boy's parent's didn't buy the initial prognosis, and 50 brain operations later, Derek is now a happy, healthy teen who just got his driver's license. Shortly after the accident and a helicopter ambulance trip to Primary Children's Medical Center, little Derek fell into a coma. While in the coma he developed a condition in which his blood wouldn't clot. He was still on the blood clotting medication when he came out of the coma only to develop a few weeks later a condition called hydrocephalus, a swelling of the brain caused by excess fluid. Doctors inserted a shunt to drain the fluids and he was finally able to go home. Soon, he was spending countless hours with therapists, neurosurgeons and neurologists. A new scare came on Derek's first birthday, when he began vomiting uncontrollably. His mother, Jan'a, rushed him to the hospital. An infection had developed in the shunt, and as a result the boy was scheduled for the first of a long series of surgeries. It's been a bumpy road, but Jan'a Maughan says it has been a road filled with miracles.

Case 8

Rail crash victim's `miracle' recovery

Independent on Sunday, the, Mar 21, 2004  by Stephen Seawright in Hong Kong

A Hong Kong television journalist who was declared brain- dead after being critically injured in the Potter's bar train crash has made a miraculous recovery and is finally hoping to return to work.  Two of Tanya Liu's friends died in the crash in May 2002. Ms Liu has spent the past two years in rehabilitation in a hospital in Beijing. She spent two months in a coma after the crash and was not able to stand up unaided until near the end of 2002. In the year after the crash, Ms Liu was operated on six times - twice for brain surgery.  Ms Liu's family claim that British doctors declared her brain dead shortly after the crash. But the family sought a second opinion from a Beijing neurosurgeon, who flew to London and said she could recover. A month after the crash, Ms Liu's family transferred her to a hospital in the Chinese capital and in July 2002 she came out of the coma.  Seven people died when the last carriage of the train traveling from King's Cross to King's Lynn derailed at Potters Bar station.  Ms Liu's family claim that in the first few weeks after the crash, doctors at the Royal Free Hospital in north London urged them to allow her to die.  A spokesperson for the Royal Free said: "I can't comment on conversations between individuals, but some of these are not the kind of expressions doctors use in these situations. Brain injury is a highly complex area of medicine and one in which it is very difficult to predict the degree and course of any patient's recovery. Ms Liu suffered a very severe injury and we were very worried about her future prospects."

Case 9

Anesthesiology: Volume 91(1) July 1999 pp 275-287

A Matter of Life and Death: What Every Anesthesiologist Should Know about the Medical, Legal, and Ethical Aspects of Declaring Brain Death                 

 Van Norman, Gail A. MD

Case 3: An anesthesiologist requests that his/her department review the events surrounding a potential organ collection. A young woman receiving intravenous magnesium sulfate for pregnancy-induced hypertension suffered seizures several hours after vaginal delivery. After the seizures, she was unarousable and posturing. She was intubated after intravenous administration of 4 mg pancuronium, and a computed tomography scan showed coning, diffuse edema, and occipital lobe infarcts. A neurologist determined that the patient had suffered a "catastrophic neurologic event." Intravenous esmolol that was being infused to control blood pressure and heart rate was discontinued, and permission was obtained from the patient's family for the patient to become a vital organ donor. On the day of anticipated organ collection, the anesthesiologist found that the donor had small, reactive pupils, weak corneal reflexes, and a weak gag reflex. The esmolol infusion was reinstituted. Further review of the patient's chart showed the previous administration of pancuronium, and a serum magnesium level of 5.1 mEq/l, more than 2.5 times normal several hours after the magnesium infusion had been discontinued. After the anesthesiologist administered edrophonium 10 mg intravenously, the patient coughed, grimaced, and moved all extremities. Vital organ collection was canceled, and after consultation with a neurosurgeon, the patient underwent placement of an intracranial pressure monitor. Intracranial pressure was initially 18 cm H2O and gradually decreased with therapy to 10 cm H2O. The patient ultimately regained consciousness and was discharged home. She was alert and oriented but suffered from significant neurologic deficits.


Case 10


Case 11


"Surprise for doctors - organ donor still alive"

  Orlando Sentinel, 9/29/90.

Curt Coleman Clark

Doctors were about to remove the organs of a 22-year-old North Carolina man they thought had been killed in a traffic accident when his foot twitched. Curt was pronounced "brain dead" and his family agreed to donate his organs. But, after his foot moved, he was taken to the intensive care unit of Baptist Hospital in Winston Salem where more signs of life were detected

Case 12

(USA Today, Feb. 14, 1989).

Another amazing case involving the recovery of one who was “brain dead” happened in December 1988. Barbara Blodgett, a 24-year-old Washington state woman who had been in a deep coma for more than five months, gave birth to a healthy baby boy and then came out of the coma and began making gradual progress toward recovery. When thirteen-weeks pregnant on June 30, 1988, Barbara was severely injured when the car she was riding in was struck by a drunk driver. Her cousin was killed in the crash and she suffered head injuries so severe that doctors proclaimed she was in a state of “cerebral death.” Yet by January 1989 she was asking questions, forming words, recognizing her family and friends, and helping in small ways to care for her newborn baby. Barbara spelled out the following message by pointing to letters on a piece of paper: “Never give up”


Case no. 13-15 in Britain October, 1980


On October 13th, 1980 a documentary film was broadcasted in the BBC concerning brain stem death (BSD) under the heading:

Are the donors really dead?

This film caused a sort of unrest in the British society and lead to a recession of the public support for organ donation due to the facts that it enclosed. Proponents of organ transplantation exerted a big deal of effort to overcome the serious repercussions of broadcasting this film. This film shed the light on the concept of BSD as well as on the controversies concerning the adoption of this concept versus the concept of whole brain death which gained wide support in the USA.



3. The Lazarus phenomenon


Patients suffering from the so called "Brain Death" can move their trunks and extremities (spontaneous, complex and purposeful movements) as if struggling to breathe after turning off the ventilator.


References of organ transplantation frankly admit that the most serious obstacle that faced the "lie of brain death" ever since it evolved was the frequently recurring spontaneous movements in patients formally diagnosed brain dead and awaiting organ harvesting. These movements extend to involve the fingers, hands, arms and shoulders as well as the feet and toes together with movements of the trunk (patients trying to rise up and struggle to breathe) along with dozens of other different forms of movements. And since these movements keep recurring in such patients it couldn't be ignored or overlooked and hence was termed "The Lazarus phenomenon". "Lazarus" is the name of the man that had been raised from the dead by Master Jesus as the bible states. For this reason the term "Lazarus" is given to the brain dead patient who experiences such movements along with other signs of life.


The "Lazarus sign" startles equally, both families and doctors:-


Some references describe "Lazarus phenomenon" as most startling for both families and doctors when they are faced by a moving "corpse" that exhibits spontaneous, purposeful complex movements, who tries to get up and struggles to breathe. Transplant doctors deny his being alive and bounce on him to extract his organs.


The incidence of this phenomenon amounts to 70-75% of cases.


This phenomenon is most obvious at the time when the ventilator is turned off during what's known as the "apnea test".


The muscular activity exhibited in the "Lazarus phenomenon" may take different forms like for instance grasping hands together, moving the legs as if walking, moving hands to shoulders or below chin or intentionally closing arms and this is why they are described as "complex and purposeful" movements.


The "Lazarus sign" is not confined to the moment when hypoxemia occurs as a result of turning the ventilator off during apnea testing. It may take place spontaneously or as a result of pain or any other sensory stimuli.


The episode of muscular activity may last a few minutes [exceeding 3.5 minutes in some cases that were video taped]


Not only does the "Lazarus sign" comprise moving the head or extremities and shoulders but it may extend to involve other signs of life such as:-

1. Coughing.

2. Rhythmic shallow irregular respiratory activity that may last for sometime after turning off the ventilator.

3. Moving the head sideways.

4. Repeated tremors of fingers and spastic movements of lower jaw and face that may last for a few seconds.


The documents that prove the fallacy of the claims denoting that "Lazarus sign" is nothing but a reflex action arising in the spinal cord.


 Recent articles that are enclosed in the following pages prove that the type of movements encountered in "Lazarus sign" go far beyond what was first thought and that they are difficult to classify. Besides, most of these movements follow a sequential pattern as if to achieve a certain purpose. For this reason it becomes obvious that it is no longer acceptable for transplantation proponents to assume that such movements are nothing but spinal reflexes.


A study done in 2005 by the American college of neurologists in New York admitted frankly that the nature of the pathophysiology of L S remained speculative. The study also suggested a new term for this intriguing phenomenon: "brain death associated automatism". This confession actually denounces all the claims put forth by transplantation proponents trying to explain "Lazarus sign" in brain dead subjects. This confession also denotes the fall of the concept of brain death altogether as it is absurd to encounter automatism in a "dead body".

A: the body in a state of relaxation

B: the left elbow is rotated and the arm moves closer to the body

D: both arms move when the left shoulder is pinched

Source: NEUROLOGY 2000; 54:224–227

Brain dead infant 11 months old







A: the body in a state of relaxation

C: the left elbow is medially closer to the body

The same child grips the doctor's hand firmly and the doctor can hardly loosens the child's grip to take away his hand

 Source: NEUROLOGY 2000;




Source: NEUROLOGY 1984; 34:1089

Lazarus sign in a 43 year old Japanese patient during apnea testing


Department of Anesthesiology & Critical Care Medicine,

Ajou University Hospital


Medical references for the Lazarus sign

Neurocritical care

Neurocrit Care.2005,3(2):122-6

Brain death-associated reflexes and automatisms

Samay Jainand Michael DeGeorgia2




Abstract   Background: In several instances, the diagnosis of brain death has been questioned due to the presence of movements. This case report and review of the literature illustrates the spectrum of movements that have been encountered in brain death.

Methods: A case report and review of the literature on movements seen in brain death was conducted.

Results: Movements in brain death are common and have a wide range of phenomenology. Several movements wax and wane over time, making movements in brain death difficult to classify. In addition, varying terminology has been used (e.g., Lazarus sign, spinal man, spinal reflexes, and spinal automatisms). Although evidence points to a spinal origin for such movements, the pathophysiology in many cases remains speculative. Characteristics of movements in brain death have been identified that can help differentiate them from brainstem or voluntary origin.

Conclusions: Based on our review, we suggest referring to stimulus-provoked movements as reflexes and spontaneous movements as automatisms. We propose using the terms brain death-associated reflexes and brain death-associated automatisms as two main categories for movements that occur in brain death. These terms do not imply a specific pathophysiology, but consistent clinically oriented nomenclature may be useful when reporting such phenomena.


European Journal of Neurology

Eur J Neurol. 2004 Nov; 11(11):723-7.

Undulating toe movements in brain death

Saposnik G, Mauriño J, Saizar R, Bueri JA.

Movements in Brain Death Study Group, Department of Neurology, Hospital JM Ramos Mejía, Universidad de Buenos Aires, Buenos Aires, Argentina. gsaposnik@yahoo.com

For many years, death implied immobility. Nevertheless, there are anecdotal reports of spontaneous or reflex movements (SRMs) in patients with Brain death (BD). The presence of some movements can preclude the diagnosis of BD, and consequently, the possibility of organ donation for transplantation. McNair and Meador [(1992), Mov Dord7: 345-347] described the presence of undulating toe flexion movements (UTF) in BD patients. UTF consists in a sequential brief plantar flexion of the toes. Our aim was to determine the frequency, characteristics and predisposing factors of UTF movements in a prospective multicenter cohort study of patients with BD. Patients with confirmed diagnosis of BD were assessed to evaluate the presence of UTF using a standardized protocol. All patients had a routine laboratory evaluation, CT scan of the head, and EEG. Demographic, clinical, hemodynamic and blood gas concentration factors were analyzed. Amongst 107 BD patients who fulfilled the AAN requirements, 47 patients (44%) had abnormal movements. UTF was observed in 25 (23%) being the most common movement (53%). Early evaluation (OR 4.3, CI95% 1.5-11.9) was a predictor of UTF in a multivariate regression model. The somato-sensory evoked potential (SSEPs) as well as brainstem auditory evoked potentials (BAEPs) did not elicit a cortical response in studied patients with UTF. This spinal reflex is probably integrated in the L5 and S1 segments of the spinal cord. Abnormal movements are common in BD, being present in more than 40% of individuals. UTF was the most common spinal reflex. In our sample, early evaluation was a predictor of UTF. Health care professionals, especially those involved in organ procurement for transplantation, must be aware of this sign. The presence of this motor phenomenon does not preclude the diagnosis of BD.

Transplantation Proceedings

Transplant Proc.2004 Jan-Feb, 36(1):17-9

Frequency of spinal reflex movements in brain-dead patients

Authors: Dosemeci L.1Cengiz M.; Yilmaz M.; Ramazanoglu A.

Spontaneous and reflex movements may occur in brain-dead patients. These movements originate from spinal cord neurons and do not preclude a brain-death diagnosis. In this study, we sought to determine the frequency and characteristics of motor movements in patients who fulfilled diagnostic criteria for brain death. Patients admitted to our department between January 2000 and March 2003 and diagnosed as brain-dead were prospectively evaluated in terms of spinal reflexes. Clinical brain death was diagnosed according to our national law. We also prefer to document the diagnosis of brain death with an EEG and/or TCD. Spinal reflex movements were observed in 18 out of 134 (13.4%) brain-dead patients during the study period. Lazarus sign, the most dramatic and complex movement seen in brain-dead patients, was observed a few times in two patients during an apnea test, an oculocephalic test, after a painful stimulus, and after removal of a ventilator. The other reflex movements observed in our brain-dead patients were finger and toe jerks, extension at arms and shoulders, and flexion of arms and feet. The occurrence of spinal reflexes in brain-dead patients may certainly delay decision making, such as starting a transplantation procedure, because of difficulties in convincing the family or even a physician taking part in the diagnosis of brain death. An awareness of spinal reflexes may prevent delays in and misinterpretations of the brain-death diagnosis

Acta Neurol Scand. 2003 Sep, 108(3):170-3

Complex spinal reflexes during transcranial Doppler ultrasound examination for the confirmation of brain death

Authors: de Freitas, G. R.1; Lima, M. A. S. D.1; André, C.1


De Freitas GR, Lima MASD, André C. Complex spinal reflexes during transcranial Doppler ultrasound examination for the confirmation of brain death.

Acta Neurol Scand 2003: 108: 170-173. © Blackwell Munksgaard 2003. Objective 

Complex sets of movements of the extremities can be seen in patients with brain death (BD), and are typically observed during apnea testing or removal of ventilatory support (also called the Lazarus sign). We here describe brain-dead patients who had not shown previous movements, even during apnea testing, but presented complex spinal reflexes during transcranial Doppler (TCD) examination elicited by neck flexion. Methods -

We performed a prospective TCD study of patients with the clinical diagnosis of BD. Results 

Four (2.5%) of 161 brain-dead patients presented complex spinal reflexes exclusively during TCD examination. TCD showed vertebro-basilar circulatory arrest in all four. Their systolic blood pressure was significantly lower than that of brain-dead patients not presenting movements during TCD examination.
Conclusions: Hypotension and mechanical stimulation play a role in the pathophysiology of complex spinal reflexes present in BD, which are not exclusively seen in terminal hypoxia. Intensive care personnel and neurologists who perform TCD to confirm BD should be aware of these movements.

Journal of the American Academy of Neurology

    Neurology 2000, 54:221

Spontaneous Movements Often Occur After Brain Death

Science Daily ST. PAUL, MN - Many brain-dead patients have spontaneous movements such as jerking of fingers or bending of toes that can be disturbing to family members and health care professionals and even cause them to question the brain-death diagnosis. These movements occur in 39 percent of brain-dead patients, according to a study published in the January 11 issue of Neurology, the scientific journal of the American Academy of Neurology.

"We found that these movements are more common than has been reported or believed," said neurologist and study author José Bueri, MD, of J. M. Ramos Mejia Hospital in Buenos Aires, Argentina. "People need to know that these movements are spinal reflexes that do not involve any brain activity."

The study examined all patients at the hospital during an 18-month period with a diagnosis of brain death. Of the 38 patients, 15 had these motor movements. In all cases, the movements were seen in the first 24 hours after brain death diagnosis, and no movements were seen after 72 hours.

Some of the movements occurred spontaneously; others were triggered by touch. Examiners used tests designed to elicit motor movements, such as lifting the arms or legs or touching the palm of the hand.

Electroencephalogram (EEG) tests did not show any brain activity in any of the patients with movements.

"If the lack of understanding of these movements leads to a delay in the brain death diagnosis or questions about the diagnosis afterwards, there can be important practical and legal implications, especially for organ procurement for transplantation," Bueri said. "Family members and others need to understand that these movements originate in the spinal cord, not in the brain, and their presence does not mean that there is brain activity.

One of the most startling movements for family members and health care professionals is called the 'Lazarus sign.' It is a sequence of movements lasting for a few seconds that can occur in some brain dead patients, either spontaneously or right after the ventilator is disconnected," Bueri said. It is named for the episode in the Bible where Lazarus is raised from the dead.

"It starts with stretching of the arms, followed by crossing or touching of the arms on the chest, and finally falling of the arms alongside the torso," he said. "It is also a spinal reflex, but it can be disturbing to family members and others who see this."

Another article in this issue of Neurology describes unusual movements in two brain dead patients. The movements occurred in a 30-year-old woman and an 11-month-old baby at a hospital in Barcelona, Spain. Both patients extended their arms, flexed their wrists and curled up their fingers each time the mechanical ventilator inflated their lungs. The movements stopped after the patients were disconnected from the ventilator.

"We had never seen these type of movements before, and they hadn't been reported in the medical journals," said neurologist Joan Martí-Fàbregas, MD, PhD, of the Hospital de la Santa Creu i Sant Pau.

The doctors conducted additional tests and confirmed that there was no brain activity. "The living cells that were ordering these muscles to move were not brain cells or brain stem cells, but cells located in the spinal cord," he said. "It's important for family members and health care professionals to be aware of this possibility."

A neurologist is a medical doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system.

The American Academy of Neurology, an association of more than 16,000 neurologists and neuroscience professionals, is dedicated to improving patient care through education and research.

The American Journal of Medicine

Volume 118, Issue 3, March 2005, Pages 311-314

Spontaneous and reflex movements in brain death

G. Saposnik, MD, J. A. Bueri, MD, J. Mauriño, MD, R. Saizar, MD and N. S. Garretto, MD

From the Department of Neurology, Hospital J.M. Ramos Mejía, Buenos Aires, Argentina.

Address correspondence and reprint requests to Dr. José A. Bueri, Department of Neurology, Hospital J.M. Ramos Mejía, Urquiza 609, Buenos Aires (1221), Argentina.

Spontaneous and reflex movements may be found in patients with brain death (BD). The authors prospectively evaluated their frequency using a standardized protocol. Among 38 patients who fulfilled criteria for BD, the authors found 15 (39%) with spontaneous or reflex movements. The most common movement was finger jerks. Undulating toe flexion sign, triple flexion response, Lazarus sign, pronation–extension reflex, and facial myokymia also were seen. These movements may be more common than reported and do not preclude the diagnosis of BD.


J Korean Med Sci 2006; 21: 588-90

ISSN 1011-8934

Reflex Movements in Patients with Brain Death: A Prospective Study in a Tertiary Medical Center

Reflex movements have been reported to occur in up to 75% of brain-dead patients, but this issue has not been addressed in Korea. The patients admitted to our hospital who met the criteria for brain death were enrolled between March 2003 and February 2005. The frequency and type of reflex movements in these patients were evaluated prospectively using a standardized protocol. Brain death was determined according to the guideline of Korean Medical Association. Of 26 patients who were included, five (19.2%) exhibited reflex movements such as the pronation - extension reflex, abdominal reflex, flexion reflex, the Lazarus sign, and periodic leg movements. This finding suggests that the frequency of spinal reflex movements is not rare and the awareness of these movements may prevent delays in brain-dead diagnosis and misinterpretations.



4. Chronic "brain death"

Some studies done by the American academy of neurologists and others which prove that some brain dead patients survived for periods exceeding 14 years simply because they were properly looked after.


 In order to fool public opinion, transplantation proponents continuously claimed that deeply comatose patients whom they presume to be brain dead cannot survive beyond two weeks no matter what. As a matter of fact this assumption contradicts medical documents as is clear from the following:-

1. From the research conducted by the American academy of neurologists concerning the life expectancy of brain dead patients it was found that many of such patients can survive from one to 14 years simply if they are properly cared for.

2. Such patients are referred to as "chronic brain dead". Chronic brain death refers to a state in which the heart of patient, even after being pronounced brain dead, does not stop beating for an extended period of time.

3. Dozens Of studies world wide have proved it possible to extend the life of a brain dead pregnant woman for several weeks of months until she delivered a healthy child. This proves beyond doubt that all organs and systems in the body of such mother are functioning satisfactorily so as to ensure the safety of the progress of pregnancy until the proposed date of delivery.


Why do transplantation proponents insist upon the imminent death of brain dead patients?

This claim only shows how desperate those proponents are to harvest the organs of such patients as soon as possible giving them no real chance for improvement or recovery. This explains why the different transplantation protocols agree upon the early retrieval of organs from such patients as soon as possible, as soon as they are pronounced brain dead (only after 24 hours in the Harvard criteria, down to 12 hours in the Minnesota protocol and cut down to Six hours in most protocols nowadays as the Saudi protocol for example).


NEUROLOGY 1998; 51:1538-1545

01998 American Academy of Neurology

Chronic "brain death".

Meta-analysis and conceptual consequences

D. Alan Shewmon, MD

From the Department of Pediatrics, Division of Neurology, UCLA Medical School, Los Angeles, CA.

Address correspondence and reprint requests to D. Alan Shewmon, MD, Department of Pediatrics, Division of Neurology, UCLA Medical Center, MDCC 22-474, and Box 951752, Los Angeles, CA 90095-1752.

Objective: One rationale for equating "brain death" (BD) with death is that it reduces the body to a mere collection of organs, as evidenced by purported imminence of asystole despite maximal therapy. To test this hypothesis, cases of prolonged survival were collected and examined for factors influencing survival capacity.

Methods: Formal diagnosis of BD with survival of 1 week or longer. More than 12,200 sources yielded approximately 175 cases meeting selection criteria; 56 had sufficient information for meta-analysis. Diagnosis was judged reliable if standard criteria were described or physicians made formal declarations. Data were analyzed by means of Kaplan-Meier curves, with treatment withdrawals as "censored" data, compared by log-rank test.

Results: Survival probability over time decreased exponentially in two phases, with initial half-life of 2 to 3 months, followed at 1 year by slow decline to more than 14 years. Survival capacity correlated inversely with age. Independently, primary brain pathology was associated with longer survival than were multisystem etiologies. Initial hemodynamic instability tended to resolve gradually; some patients were successfully discharged on ventilators to nursing facilities or even to their homes.

Conclusions: The tendency to asystole in BD can be transient and is attributable more to systemic factors than to absence of brain function per se. If BD is to be equated with death, it must be on some basis more plausible than loss of somatic integrative unity.


Current Debate on the Ethical Issues of Brain Death

Masahiro Morioka

-- Proceedings of International Congress on Ethical Issues in Brain Death and Organ Transplantation, University of Tsukuba, (2004):57-59

Dr. Allan Shewmon showed in 1998 that the hearts of many brain dead patients kept beating more than a week. 20 patients’ hearts kept beating for at least two months, seven patients’ hearts for at least six months, and the longest case was 14.5 years—this patient became brain dead at the age of four, and his heart is still beating now]. Most brain death laws were established before these findings. And even now many specialists do not know this fact in Japan. In these cases, the brain dead bodies become medically stable after the acute stage, and this fact is contrary to the general public’s belief about brain death.……………………………………………………
        In 1995, a baby was born in a rural area of Japan but soon became brain dead (no spontaneous breathing, no brain stem reflexes, flat brain waves). In Japan, we have no legal criteria of brain death for children under the age of six. If we had had such criteria, this baby would have been diagnosed as brain dead. Her parents believed that their brain dead baby was still alive, and named her “Hina.” They loved her, cared for her in the hospital, and their baby “lived” to the age of four with a respirator, in the state of brain death.
        The medical staff encouraged the parents and celebrated Hina’s birthday every year. Hina grew taller and weighed 13 kilograms when she was one year old. When Hina “died” at age four, the parents slept with her cold body, and felt happiness recalling the past four years. If the doctors had declared death and organs had been removed, the parents would have never experienced these four years with Hina.