Organ Donation – Are Brain Dead Really Dead?

In the blog entry titled, Vital Organ Donation – The Most Important Question, I proposed the following “most important question.”

The question:  Is it possible for a person to be dead while their body is still alive?

The answer one gives to this question depends on what one believes is the make-up of a living person.  The true answer to this question comes only from a true understanding of what it is to be a living person.  From a biblical perspective, with death of a person, the body goes to the dust and the soul goes to wait to be reunited with the body to face judgment at the last day.  Most would agree that a person whose body is given up to the dust is dead, but what about a person whose body remains alive? (There is further discussion on personhood, what it means to be a person, in my blog posts titled, Personhood-What Is It? and Personhood-Image of God.

Early in the history of organ donation, a new definition of death was developed that is referred to as brain death.  Prior to this a person was dead when breathing and circulation stopped.  Development of mechanical breathing machines and mechanical pumps to assist circulation came with the question, is it possible to continue to moving air in and our of the lungs and move blood through the body even after the body has died?  Early on, the test was fairly simple.  If, after the mechanical machines were removed, breathing and circulation continued then death could not be declared.  If breathing and circulation did not continue, death could be declare in the traditional way.  But, when did the person die?  The answer to this question did not really matter, until we started to want living organs for donation.  To harvest living organs, we needed living bodies.  So comes the question, Is it possible for a person to be dead while the body is still alive?  For organ donation, we want the answer to this question to be, yes?  The development of the definition of brain death served a useful purpose for those wanting living organs for transplant.  Proponents of brain death say, if the brain is dead the person is dead.  If this is true, then it is possible for a person to be dead, while their body is still alive.

Brain death can be divided into two groups.

First, there are those whose brains have lost their blood supply, leading to true death of the cells of the brain. This group is relatively rare.  I will call these living bodies with clearly dead brains.  Homeostasis in the body is dependent on neurological and hormonal brain functions.  So, even with life support, the body will not be kept functioning for long.  But what about the person, the body-soul person?   Is the body now ready for the dust and the soul gone to wait for the last day?  Or is the body-soul still united, while the body remains alive?

If a person is fully physiological, with no true soul component, then the definition of death does not really matter.  When physiologic decline is irreversible and the person is unable to give their own direction, then it really does not matter whether you relegate them to the dust now or later.  The end result is the same.   But If, as the bible teaches, people have souls, that remain after the body goes to the dust, to one day be reunited with the body, then what we do, can matter, even after our bodies have returned to the dust.  If a person is more than body (more that physiological) and all living persons have intrinsic value then the definition of death does matter.

Second, there are those whose brains have not lost their blood supply and brain cells remain alive, but whose brains are unable to give the required meaningful evidence of function.  This, I believe, is the case with many of those who are declared brain dead. A declaration of brain death, while brain cells remain alive, must be further divided into those with an irreversible loss of function and those with a reversible loss of function.

We are able to cause reversible loss of meaningful function with anesthetics or even an overdose of alcohol.   In other cases, like head injuries, how do we really know if loss of function is irreversible?  There are cases of people who have regained meaningful brain function after long periods of time of apparent lack of function.  Should we presume that we can know that a brain, that has lost significant function, will never heal to the point of regaining function?

Another question is what is a meaningful loss of function?  Is it inability to communication with our senses?  Is it being unable to display any brain reflexes?  Is it being unable to show any evidence that the brain controls anything in the body.  If I understand things correctly, many centres use a number of tests, such as reflexes, eye movements, response to painful stimuli, spontaneous breathing movements, etc.  These tests do not directly measure what is happening in the brain stem or brain.  They are based on the bodies response to stimuli from the brain.  There are studies that have shown that brains of those declared brain dead, by relatively rigorous criteria, still for many hours produce hormones that control things in the body.  Where does one draw the line?

Again, there are two types of brain death.  As described, the first is absolute brain death, where all cells of the brain are dead.  This is likely a rare condition.  Then there is functional brain death, where the brain is said to have an irreversible loss of function.  This is, by far, the majority of people who have been rigorously diagnosed as being brain dead, while their bodies are still alive.  This means that most of those diagnosed as being brain dead, still have living cells in their brains, and have living bodies.  How do we know that they are really dead?

Prior to this century, death was defined by an absence of respiration (lung) and circulation (heart).  An absence of these is always followed in a very short period of time by an absence of neurological (brain) function.  If all three of these are absent a person is clearly dead.  What about when part of any of these systems continues to function?


To learn more about concerns with the definition of death and organ donation, you can refer to the annotated menu of other related blog postings here


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