Donation After "Brain Death" (DBD)
We contend that the “brain dead” organ donor is biologically alive
The UDDA criteria have remained controversial. The Center for Bioethics at Harvard medical school held a conference in 2018 to re-evaluate the 50-year legacy of their redefinition of death. The consensus of the conference was that the UDDA is best used as a legal instrument to represent death in the US, not as a way to describe death as a biological occurrence.
We affirm that the “brain dead” organ donor is biologically alive, and the Harvard conference participants agree with us. Thus, it is morally reprehensible to use these biologically alive people as a source of spare parts. So called “brain death” is a legal fiction, and we need to protect these vulnerable people from being brutally murdered by the harvest of their organs, often without the benefit of adequate anesthesia.
In October of 2023, the American Academy of Neurology published a new brain death guideline for physicians. This guideline makes it easier to declare someone brain dead. It allows people who still have ongoing brain function, such as electrical activity on EEG or continuing function of a part of the brain called the hypothalamus, to be declared "dead" and their organs harvested. This guideline does not comply with the law under the UDDA (which requires the irreversible cessation of all functions of the entire brain) making physicians who use the new guideline vulnerable to lawsuits.
The Condition Explained?
How could doctors misdiagnose living people as being "brain dead"? A condition called "Global Ischemic Penumbra", or GIP, could explain this.
Like every other organ, the brain shuts down its function when its blood flow is reduced in order to conserve energy. At 70 percent of normal blood flow, the brain’s neurological functioning is reduced, and at a 50 percent reduction the EEG becomes flatline. But tissue damage doesn’t begin until blood flow to the brain drops below 20 percent of normal for several hours. GIP is a term doctors use to refer to that interval when the brain’s blood flow is between 20 and 50 percent of normal. During GIP the brain will not respond to neurological testing and has no electrical activity on EEG, but still has enough blood flow to maintain tissue viability -- meaning that recovery is still possible. During GIP, a person will appear “brain dead” using the current medical guidelines and testing, but with continuing care could potentially improve.
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Dr. D. Alan Shewmon, one of the world’s leading authorities on brain death, describes GIP this way:
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“This [GIP] is not a hypothesis but a mathematical necessity. The clinically relevant question is therefore not whether GIP occurs but how long it might last. If, in some patients, it could last more than a few hours, then it would be a supreme mimicker of brain death by bedside clinical examination, yet the non-function (or at least some of it) would be in principle reversible.”
Dr. Cicero Coimbra first described GIP in 1999, but in the never-ending quest for transplantable organs, his work has been largely ignored.
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After the ad hoc committee of Harvard medical school redefined irreversible coma as death in 1968, in 1981 their recommendations were written into a model law for adoption by the states as the Uniform Determination of Death Act (UDDA). The UDDA defines brain death as the irreversible cessation of all functions of the entire brain, including the brainstem.
However, in actual medical practice, only the brainstem is tested, and only with a bedside physical exam. No specialized tests such as an EEG or cerebral blood flow test are required by this law.
