Why the Brain Death Concept and Standards are Illegitimate

I was honored to speak at this national conference on brain death, and the video of my presentation is now available for viewing: https://www.youtube.com/watch?v=FQptClaehFM

My lecture begins with my experience anesthetizing a "brain dead" young man during my residency training. Why does a dead person need an anesthetic? I then review the origins of the brain death concept, which is grounded in utilitarianism rather than biological reality. In fact, utilitarian philosopher Dr. Peter Singer calls brain death an ethical choice masquerading as a medical fact.

I go on to describe the only prospective, multicenter neuropathology study of brain death which showed that the majority of "brain dead" people's brains were not totally destroyed on autopsy evaluation, and that ten of these brains were actually grossly normal. The authors of the study concluded that "brain death" is a prognosis, not a diagnosis of death.

I discuss the Presidential Commissions/Councils that have been convened to study brain death, and the mistakes, duplicity, and lack of consensus involved. I review the studies showing that brain dead people can and do continue to live if given proper care.

I address the lack of evidence for the standards used by the American Academy of Neurology (AAN) brain death guideline. I show that attempts to improve the AAN guideline by adding tests of hypothalamic function are futile, since Jahi McMath not only met (and exceeded) the requirements of the AAN guideline but she also lacked hypothalamic function at the time of her brain death diagnosis. Yet, after she was transferred to New Jersey and given proper care, she improved. Two neurologists who examined her there found that she no longer met the criteria for brain death, but was in a minimally conscious state. True death is an irreversible state; if you can improve, you were never dead!

I review Global Ischemic Penumbra (GIP), which may explain why people who meet the AAN requirements can potentially recover. During periods of low blood flow, the brain (like every other organ) shuts down its functions to save energy. But brain tissue destruction doesn't occur until brain blood flow is much more markedly reduced over several hours. During GIP, there is not enough flow to support function, but there still is sufficient flow to prevent tissue breakdown. People in a state of GIP exactly mimic "brain death," but with treatment to improve brain blood flow they have the potential to improve.

In summary, I conclude that the "Emperor" brain death has no clothes...and that the "Fig Leaf" of added hypothalamic testing will not cover him! The brain death concept does not reflect the reality of death, and no amount of additional testing can make this indefensible concept defensible.