Irreversible apnoeic coma 35 years later: Towards a more rigorous definition of brain death?

Nereo Zamperetti, Rinaldo Bellomo, Carlo Alberto Defanti, Nicola Latronico

Research output: Contribution to journalReview ArticleResearchpeer-review

42 Citations (Scopus)

Abstract

The concept of brain death (BD) has been widely accepted by medical and lay communities in the Western world and is the basis of policies of organ retrieval for transplantation from brain-dead donors. Nevertheless, concerns still exist over various aspects of the clinical condition it refers to. They include the utilitarian origin of the concept, the substantial international variation in BD definitions and criteria, the equivalence between BD and the donor's biological death, the practice of retrieving organs from donors who are not brain-dead (as in non-heart-beating organ donor protocols), the proposal to abandon the dead donor rule and attempts to overcome these problems by adapting rules and definitions. Suggesting that BD, as it was originally proposed by the Harvard Committee, is more a moral than a scientific concept, we argue that current criteria do not empirically justify the definition of BD; yet they consistently identify a clinical condition in which organ retrieval can be morally and socially justified. We propose to revert to the old term of "irreversible coma" or, better yet, of "irreversible apnoeic coma", thus abandoning the presumption of diagnosing the death of all intracranial neurons and/or the patient's biological death. On the other hand, we think that a (re)definition of the vital status of donors identified on neurological criteria can only occur through a prior (re)definition of death, a task which is not only medical but societal.

Original languageEnglish
Pages (from-to)1715-1722
Number of pages8
JournalIntensive Care Medicine
Volume30
Issue number9
DOIs
Publication statusPublished - 1 Sep 2004
Externally publishedYes

Keywords

  • Brain death
  • Death
  • Irreversible apnoeic coma (IAC)
  • Non-heart-beating organ donors (NHBD)
  • Transplantation

Cite this

Zamperetti, Nereo ; Bellomo, Rinaldo ; Defanti, Carlo Alberto ; Latronico, Nicola. / Irreversible apnoeic coma 35 years later : Towards a more rigorous definition of brain death?. In: Intensive Care Medicine. 2004 ; Vol. 30, No. 9. pp. 1715-1722.
@article{16bdd53427e34d3da7070f19bbe60186,
title = "Irreversible apnoeic coma 35 years later: Towards a more rigorous definition of brain death?",
abstract = "The concept of brain death (BD) has been widely accepted by medical and lay communities in the Western world and is the basis of policies of organ retrieval for transplantation from brain-dead donors. Nevertheless, concerns still exist over various aspects of the clinical condition it refers to. They include the utilitarian origin of the concept, the substantial international variation in BD definitions and criteria, the equivalence between BD and the donor's biological death, the practice of retrieving organs from donors who are not brain-dead (as in non-heart-beating organ donor protocols), the proposal to abandon the dead donor rule and attempts to overcome these problems by adapting rules and definitions. Suggesting that BD, as it was originally proposed by the Harvard Committee, is more a moral than a scientific concept, we argue that current criteria do not empirically justify the definition of BD; yet they consistently identify a clinical condition in which organ retrieval can be morally and socially justified. We propose to revert to the old term of {"}irreversible coma{"} or, better yet, of {"}irreversible apnoeic coma{"}, thus abandoning the presumption of diagnosing the death of all intracranial neurons and/or the patient's biological death. On the other hand, we think that a (re)definition of the vital status of donors identified on neurological criteria can only occur through a prior (re)definition of death, a task which is not only medical but societal.",
keywords = "Brain death, Death, Irreversible apnoeic coma (IAC), Non-heart-beating organ donors (NHBD), Transplantation",
author = "Nereo Zamperetti and Rinaldo Bellomo and Defanti, {Carlo Alberto} and Nicola Latronico",
year = "2004",
month = "9",
day = "1",
doi = "10.1007/s00134-003-2106-3",
language = "English",
volume = "30",
pages = "1715--1722",
journal = "Intensive Care Medicine",
issn = "0342-4642",
publisher = "Springer-Verlag London Ltd.",
number = "9",

}

Irreversible apnoeic coma 35 years later : Towards a more rigorous definition of brain death? / Zamperetti, Nereo; Bellomo, Rinaldo; Defanti, Carlo Alberto; Latronico, Nicola.

In: Intensive Care Medicine, Vol. 30, No. 9, 01.09.2004, p. 1715-1722.

Research output: Contribution to journalReview ArticleResearchpeer-review

TY - JOUR

T1 - Irreversible apnoeic coma 35 years later

T2 - Towards a more rigorous definition of brain death?

AU - Zamperetti, Nereo

AU - Bellomo, Rinaldo

AU - Defanti, Carlo Alberto

AU - Latronico, Nicola

PY - 2004/9/1

Y1 - 2004/9/1

N2 - The concept of brain death (BD) has been widely accepted by medical and lay communities in the Western world and is the basis of policies of organ retrieval for transplantation from brain-dead donors. Nevertheless, concerns still exist over various aspects of the clinical condition it refers to. They include the utilitarian origin of the concept, the substantial international variation in BD definitions and criteria, the equivalence between BD and the donor's biological death, the practice of retrieving organs from donors who are not brain-dead (as in non-heart-beating organ donor protocols), the proposal to abandon the dead donor rule and attempts to overcome these problems by adapting rules and definitions. Suggesting that BD, as it was originally proposed by the Harvard Committee, is more a moral than a scientific concept, we argue that current criteria do not empirically justify the definition of BD; yet they consistently identify a clinical condition in which organ retrieval can be morally and socially justified. We propose to revert to the old term of "irreversible coma" or, better yet, of "irreversible apnoeic coma", thus abandoning the presumption of diagnosing the death of all intracranial neurons and/or the patient's biological death. On the other hand, we think that a (re)definition of the vital status of donors identified on neurological criteria can only occur through a prior (re)definition of death, a task which is not only medical but societal.

AB - The concept of brain death (BD) has been widely accepted by medical and lay communities in the Western world and is the basis of policies of organ retrieval for transplantation from brain-dead donors. Nevertheless, concerns still exist over various aspects of the clinical condition it refers to. They include the utilitarian origin of the concept, the substantial international variation in BD definitions and criteria, the equivalence between BD and the donor's biological death, the practice of retrieving organs from donors who are not brain-dead (as in non-heart-beating organ donor protocols), the proposal to abandon the dead donor rule and attempts to overcome these problems by adapting rules and definitions. Suggesting that BD, as it was originally proposed by the Harvard Committee, is more a moral than a scientific concept, we argue that current criteria do not empirically justify the definition of BD; yet they consistently identify a clinical condition in which organ retrieval can be morally and socially justified. We propose to revert to the old term of "irreversible coma" or, better yet, of "irreversible apnoeic coma", thus abandoning the presumption of diagnosing the death of all intracranial neurons and/or the patient's biological death. On the other hand, we think that a (re)definition of the vital status of donors identified on neurological criteria can only occur through a prior (re)definition of death, a task which is not only medical but societal.

KW - Brain death

KW - Death

KW - Irreversible apnoeic coma (IAC)

KW - Non-heart-beating organ donors (NHBD)

KW - Transplantation

UR - http://www.scopus.com/inward/record.url?scp=4644281654&partnerID=8YFLogxK

U2 - 10.1007/s00134-003-2106-3

DO - 10.1007/s00134-003-2106-3

M3 - Review Article

C2 - 14722634

AN - SCOPUS:4644281654

VL - 30

SP - 1715

EP - 1722

JO - Intensive Care Medicine

JF - Intensive Care Medicine

SN - 0342-4642

IS - 9

ER -