"Brain death"
A lie destined to die

ERRONEOUS DIAGNOSIS OF BRAINSTEM
DEATH: A COMMON PRACTICE

Three case reports appeared lately in the literature (25). The three cases represented fatal mistakes in diagnosing brainstem death. In the first case the patient began to breathe spontaneously upon receiving a dose of neostigmine. It was too late because the liver had  already been removed. In the second case, during organ harvesting, the anesthesiologist noticed that the donor was breathing spontaneously. When he inquired about that the answer was: "the donor was not going to recover, he could be declared brain (dead". In the third case, the patient was suffering from eclamptic fits for which she was receiving magnesium sulfate and esmolol. A neurologist determined that the patient had suffered "a catastrophic neurologic insult" and declared her brainstem dead. During organ retrieval, the anesthesiologist noticed small reactive pupils together with weak corneal and gag reflexes. Upon stopping of magnesium infusion and receiving edrophonium, the patient recovered and was eventually discharged home. Such fatal mistakes appear in the literature repeatedly(57-58) and cannot be explained by mere negligence or ignorance. Several causes can be proposed to explain these repeated errors:

1.    The controversial nature of the concepts, and hence criteria, defining brain death.

2.  The difficulty to  interpret the tests for verifying the diagnosis. This is better appreciated if we know that about 45% of brain stem dead renal donors (in such a developed country as the UK) came from centers  where there were no neurosurgical facilitics(60). It is then expected to have a high degree of error.

 

3.  The shortness of time available for excluding drug intoxication or metabolic errors before retrieving organs from a dying donor for a,, desperate  receipient. Dr. David wainwright Evans(61) , an English cardiologist  in cambridgeshire, states that  the additional test , which saved these two, was the passage of time one of most powerful  diagnostic weapons available to the doctor, yet  one which  is almost casually set aside when neurologists are under  pressure to provide  viable organs for transplantation.

 

4.  Regarding brainstem failure patients as hopeless (considering them dead already,  

    one cannot benefit them ) and focusing on preserving  

     their organs (being potential organ donors). Dr. Watanabe, (62) a leading Japanese 

      cardiologist says that a hastened judgment of brain death    without  trying such new     

     therapeutic measures  would well constitute murder , or at     least  a malpractice case.  

     If all transplant protagonists try to ignore these observations, while at the  same time

      claim  the validity of current diagnostic  criteria of brain death,  and continue to give

      apnoea tests to aggravate ischaemic brain  injury, I must conclude that the use of

      terms such as biomort or heart- beating  cadaver is  nothing but a  sophism to disguise

       their real intention  that the only thing they want  is transplantable   organs. They are

      not  at all interested in saving those donor candidates. Other critics in Japan claim the apnoea test has been performed  there repeatedly to achieve brain death rather than diagnose it .

 

 

5.         The potential   reversibility of brainstem failure. Recovery in such cases  would  

            be wrongly attributed to false diagnosis.