The brain death: death or life?
STAVROS J. BALOYANNIS
1st Department of Neurology, Aristotelian University, Thessaloniki, Greece.
The concept of brain or total brain death is an alternative to the older definition of death or cardiac death, caused by permanent and irreversible cessation of circulatory and respiratory function. The unanimous acceptance of neurological criteria of irreversible cessation of all functions of the entire brain is important for the clinical diagnosis of the brain death in the various medical centers and the intensive care units. Serial neurological examinations in frequent time intervals are imperative for declaring brain death at betside. Confirmatory laboratory tests are necessary to supplement the clinical diagnosis of brain death, mainly when rapid brain death determination is desirable to facilitate organ retrieval for transplantation. The confirmatory tests exclude any viability of the brain, by the documentation of the necrosis of the entire brain. Tests that are often employed are EEG, BAER, brain angiography, radionuclide angiography, SPECT, transcranial Doppler ultrasonography and xenon-enhanced computer tomography. From the neuropathological point of view brain oedema and cerebral herniations are seen immediately after the arrest of the intracranial blood flow, followed by extensive necrosis of neurons and glial cells in the entire brains, including the brain stem. Some dayw later the brain is autolized. The brain death is closely related to organ transplantation By acceptance of brain death as death and by the donation of organs as an act of charity, the tragedy of death, via the extension of the human life, is transformed to a ministry of love to others.