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Brain death: an important paradigm shift in the 20th century
1Department of Surgical Sciences, Karolinska Institute, Stockholm, Sweden. ggsettergren@swipnet.se
Acta Anaesthesiologica Scandinavica
|September 13, 2003
Summary
The understanding of death evolved from focusing on the heart to the brain. Early experiments showed artificial ventilation could sustain a beating heart after brain injury, predating modern brain death definitions.
Area of Science:
- Medical history
- Neuroscience
- Cardiology
Background:
- The definition of death has shifted from cardiac to neurological criteria over the past century.
- Understanding of increased intracranial pressure (ICP) and its effects on brain function has evolved significantly.
Purpose of the Study:
- To investigate the historical evolution of the concept of brain death.
- To trace the contributions of key neurosurgeons and the development of artificial ventilation in defining death.
Main Methods:
- Historical review of medical literature and experimental studies from 1866 to 1967.
- Analysis of contributions from prominent neurosurgeons (Horsley, Cushing, Wertheimer, Frykholm).
- Examination of early discussions on ventilator cessation and clinical applications in heart surgery.
Main Results:
- Experimental evidence in the late 19th century demonstrated that artificial ventilation could maintain cardiac function in the absence of spontaneous respiration due to high ICP.
- Significant neurosurgical contributions occurred between 1894 and 1965.
- Discussions regarding ventilator withdrawal in brain-dead patients began in 1959.
- Brain death concepts were incidentally applied in cardiopulmonary bypass surgery before formal terminology emerged.
Conclusions:
- The historical trajectory shows a gradual shift towards neurological criteria for defining death.
- Early research and clinical observations foreshadowed the modern concept of brain death and its implications for life support.