brain death

All right, let's start with our first question.

What is the basic definition of brain death? Brain death is defined as the permanent loss of function of the brain as a whole, including the brain stem, resulting in coma, absent brain stem reflexes, and apnea.

Here's a short history lesson.

In 1980, the Uniform Determination of Death Act, or UDDA, was developed as a model law for states to adopt.

It recognizes death as either irreversible cessation of circulatory and respiratory function or irreversible cessation of all functions of the entire brain, including the brain stem.

This model law was meant to promote a consistent legal standard for determining death across the United States, so someone couldn't be dead in, say, California, but alive in Oregon.

So now that we know what makes someone brain dead, let's look at how we actually go about declaring brain death.

What injury must a patient have to even be considered for brain death testing? Brain death is only considered in a patient with a known catastrophic permanent brain injury that could cause brain death.

Everybody be safe out there.

Brain Dead.

Morning, Steve.

Happy Two Tacos Tuesday.

The brain is an important organ.

So we're excited to have our first neurologist, neurointensivist guest on to tell us about brain death, which is a very important topic in the neuro ICU, but also more generally.

So it's gonna be a great one.

Get excited.

He's a neurologist and neurointensivist.

He attended medical school and neurology residency at Columbia and then did a fellowship in neurocritical care at UW.

Fortunately for us, two of his greatest professional passions include brain death and medical education, and so he is actually the perfect person to have on this episode.

[static]

And organ protection, disparities in care, and ACLS.

Let's start with arguably the most sobering and heavily regulated topic in the ICU, neurologic concerns and the declaration of brain death.

The clinical definition of brain death is the complete irreversible loss of all cerebral and brainstem function.

From both a legal and ethical standpoint across the United States, this state is considered exactly equivalent to cardiopulmonary death.

The diagnosis is usually made by a meticulous, standardized clinical neurological exam alone, performed by two independent physicians.

In those specific cases, or routinely as a supplement in young children, we rely on ancillary diagnostic tests.

The literature notes that tests of cerebral blood flow, specifically assessing brain perfusion, are considered the most reliable standalone laboratory examinations when the clinical exam cannot be applied.

The definitive diagnostic test, meaning the single best test to legally confirm brain death in these murky situations, is a brain radionucleotide perfusion scan.

So they don't have to be metapolahim.

So when is he considered dead? So in recent years, there was a whole international pilpul about brain death.

So does the halacha recognize brain death? So the pastor says that no, the halacha does not recognize brain death.

The halacha seems to define the chuvahs of Rav Moshe Feinstein.

The chuvahs that he has about brain death...

he got the impression he didn't know what brain death was.

He doesn't, he doesn't seem to, they didn't explain it to him, what brain death is.

But other tshuvas he talks, he has, there was a pilpul years ago, years, years ago, in the early 1900s, a person is, had a stroke, and the left side of his body is paralyzed.

For instance, you can't take a heart out of a corpse because the heart has stopped beatings and the heart has already started to deteriorate very, very quickly.

so the question then was we need to understand what is life and what is death far more accurately and there was a whole series of symposiums and discussions and research done in the united states to define exactly what we mean when we talk about death and this is why we end up with the confusing terms of brain death and clinical death now People will turn around and say that some people have had near-death experiences and they have died and come back.

Nobody has had brain death and come back because by definition you cannot come back from brain death.

It's when the brain has ceased function.

It's when there is no oxygen available in the brain.

Other cells in the body and other organs in the body can generate their own energy.

Whereas brain cells can't.

so therefore they need oxygen and no more than two or three minutes of loss of oxygen to the brain and the brain is irreparably damaged and there is no coming back from that so the question then is at what point do we decide what death is now what is intriguing is different states of the united states have different definitions of what death is and what brain death is.

Because that's silly.

And, you know, having actually recently seen Dead Alive or Brain Dead for

those

Down Under and Kiwis.