The mid-20th century saw the first successful organ transplantations. The notion that organs from deceased people can be used to serve the living is many centuries old, the most prominent example being Mary Shelley's Frankenstein or The Modern Prometheus from 1818 ( Figure 1). An Historical Overview of Organ Donation After Brain Death and Circulatory Death As such, its intention is to share the author's personal view in an entertaining manner rather than to provide an exhaustive and strictly balanced review of the literature. The work is based on a lecture that was due for presentation at a conference meeting canceled during the COVID-19 pandemic in 2020. This paper highlights salient aspects of death and the dying brain, aiming to provide busy neurologists with a rapidly accessible overview including graphic information. Proposed biological mechanisms underlying NDE include temporoparietal lesions ( 9), N-methyl-D-aspartate receptor (NMDAR) hypofunction ( 10), rapid eye movement (REM) sleep intrusion ( 11), and migraine aura ( 12), all of which are familiar to neurologists. In addition, neurology may offer a window to understand near-death experiences (NDE) which are empirically testable despite their mystic flavor. Recent attempts of brain resuscitation in an animal model add another layer of complexity ( 8). This is an important ethical problem because the amount of time elapsed is positively correlated with the certainty of lost brain function but negatively with the tissue quality of organ transplants ( 3, 5– 7). In these cases, neurologists are typically consulted to confirm that meaningful recovery of brain function is futile, which requires proficiency in neuro-prognostication ( 3, 4).įurther, knowledge about the cellular processes in the brain taking place after circulatory arrest is important to determine how much time should pass between cardiac standstill and organ procurement ( 3, 5). In addition, donation after circulatory death (DCD) is increasingly practiced when brain-injured patients are deemed unlikely to enter brain death before withdrawal of life-sustaining therapy ( 2). The most obvious arena where this expertise is needed concerns the determination of brain death in a potential organ donor ( 1). While the protection and repair of brain function is the raison d'être for the practicing neurologist, neurological expertise can also be applied to the transition from life to death. The aim is to provide the reader with a thorough understanding that the boundaries within the neurology of death and the dying brain are being pushed just like everywhere else in the clinical neurosciences. death-feigning, a common behavioral trait in the animal kingdom) represents the evolutionary origin of near-death experiences and speculates about the future implications of recent attempts of brain resuscitation in an animal model. This essay in pictures highlights areas of neurological expertise needed for brain death determination shows pitfalls to avoid during the clinical examination and interpretation of confirmatory laboratory tests in brain death protocols illustrates the great variability of brain death legislations around the world discusses arguments for the implementation of donation after circulatory death (DCD) points to unresolved questions related to DCD and the time between cardiac standstill and organ procurement (“hands-off period”) provides an overview of the epidemiology and semiology of near-death experiences, including their importance for religion, literature, and the visual arts suggests biological mechanisms for near-death experiences such as dysfunction of temporoparietal cortex, N-methyl-D-aspartate receptor antagonism, migraine aura, and rapid eye movement sleep hypothesizes that thanatosis (aka. 2Department of Clinical Medicine, University of Copenhagen, Copenhagen, DenmarkĪs neurologists earn their living with the preservation and restoration of brain function, they are also well-positioned to address the science behind the transition from life to death.1Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |