50 years old brain death report
Fifty years ago in August 1968, Harvard University introduced a new definition of death based on branches of neural function. Until then, death was the cessation of blood flow (or heart function) and respiration. The report, led by anesthesiologist Henry Beecher, emphasizes that the report aims to redefine death based on irreversible coma.
Advances in intensive care in the 1950s allowed physicians to keep patients with no neurological or cognitive activity alive for some time with artificial respiration, with only their heart and lungs working, but Was this kind of life valuable? On the other hand, the success of organ transplants raised the issue of organ donation at the same time. Is it possible to have their limbs removed and transplanted into the bodies of patients in need before their hearts stop beating? The ultimate goal of the Harvard University report on poor leadership was originally around these two axes:
1. Evaluate the exact definition of brain death or irreversible coma, especially considering issues such as its impact on patients, their families, and the hospital.
2. Paying attention to organ donation from such patients for the purpose of organ transplantation.
The first heart transplant in December 1967 in South Africa also fueled the controversy. The Harvard report provided specific criteria for defining brain death. The report stated that if the patient does not respond to external stimuli within 24 hours, then due to the lack of any reflexes and the absence of any brain waves, he suffers an irreversible coma and is considered dead. At the same time, the discussions took place in the United Kingdom, Switzerland (World Health Organization), South Africa and Australia, and endorsed the Harvard report. According to the report, by confirming brain death, the patient’s treatment can be stopped. It is also possible that he used the organs of these patients for transplantation before the heart stopped beating, but this report had no legal value. The legal process of accepting this report was gradually completed. Kansas was the first state to legalize this in 1970. In 1981, the United States passed a unified bill defining brain death.
According to this law, death is achieved in two cases:
1. Irreversible cessation of blood flow or respiration
2. Irreversible cessation of all brain function.
In this way, the concept of brain death was medically and legally validated. The Abrahamic religions and many non-Abrahamic religions have confirmed this to this day. It should be noted that so far no patient has regained consciousness after confirmation of brain death. Coma can have many causes, some of which are reversible, but brain death is irreversible. These patients will usually experience cardiac and respiratory arrest within hours and rarely days. Therefore, during this period, there is an opportunity to either discontinue their treatment to prevent further suffering of the family and perhaps the patient himself, or, if possible, use their members to treat patients in need. Fifty years after Harvard University reported on brain death and its progression in the world, many questions remain; As an example, the definition of brain death refers to the cessation of all brain functions. It should be noted that the human brain is composed of two parts, the cerebral cortex and the brainstem. The cerebral cortex is associated with things like thinking, moving, and feeling. The brainstem is also associated with plant activities such as automatic heart function or respiration. In many cases, the patient has severe cortical damage, but the brainstem continues to function. In these cases, the person will have only plant life and has no cortical function. Many believe that this type of life is humanly worthless and want to limit the definition of brain death to cortical dysfunction. In our country, fortunately, with the opinion of medical elites, religious scholars and the Islamic Consultative Assembly, brain death has been confirmed and their members can be used for transplantation. Each brain dead patient can save eight lives. The heart, lungs, liver, kidneys, pancreas, small intestine and even tissues (cornea, bone, cartilage, skin, etc.) of these patients can be used to help treat patients in need. Of course, the prior consent of the patient or the parents is also important, which requires creating a culture and familiarizing people in the community with the concept of brain death.
Dr. Reza Saidi Firoozabadi – Transplant Surgeon