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Chronic "brain death": meta-analysis and conceptual consequences

D A Shewmon1

  • 1Department of Pediatrics, UCLA Medical School, Los Angeles, CA, USA.

Neurology
|December 17, 1998
PubMed
Summary
This summary is machine-generated.

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Brain death (BD) patients can survive for extended periods, challenging the notion that BD equates to immediate organ death. Hemodynamic stability and primary brain pathology influence prolonged survival capacity.

Area of Science:

  • Neurology
  • Critical Care Medicine
  • Forensic Pathology

Background:

  • The concept of brain death (BD) is often equated with somatic death due to the presumed imminent asystole.
  • This study investigates the validity of this assumption by examining prolonged survival in BD cases.

Purpose of the Study:

  • To test the hypothesis that brain death leads to an immediate loss of somatic integrative unity.
  • To identify factors influencing survival capacity in patients diagnosed with brain death.

Main Methods:

  • Meta-analysis of 56 cases with reliable brain death diagnosis and survival of at least one week.
  • Kaplan-Meier survival curves were used, with treatment withdrawals as censored data.

Main Results:

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  • Survival probability decreased exponentially, with a half-life of 2-3 months initially, and a slow decline over 14 years.
  • Survival capacity correlated inversely with age and was longer in primary brain pathology cases compared to multisystem etiologies.
  • Initial hemodynamic instability often resolved, with some patients discharged on ventilators.

Conclusions:

  • The tendency to asystole in brain death is transient and influenced by systemic factors, not solely the absence of brain function.
  • Equating brain death with death requires a more robust justification than the loss of somatic integrative unity.