The answer to this question is not as simple as it might seem to an uninformed person, writes New Scientist magazine. The fabulous definition is not suitable here: "The patient is more likely alive than dead", or vice versa.
Meanwhile, the exact knowledge of the moment when a person goes from this light to that one is very important for transplantologists. After all, the success of the transplant largely depends on how quickly donor organs move from one host to another …
Historically, the moment of a person's death began to interest his fellow tribesmen about 100,000 years ago, when our ancestors began to bury the dead. Since then, death has acquired a symbolic and ritual significance. Nigel Barley, an anthropologist at the British Museum, London, points out that there are many definitions of death.
For example, on Eddystone Island (Solomon Islands), the deceased is called mate, which simultaneously characterizes an old and very sick person. The Dawayo tribe living in the north of Cameroon has always considered coma to be death. And at the same time, representatives of Hinduism officially consider a person dead only after the last coals are extinguished on the funeral pyre of the deceased.
For a long time, the time of death was announced by priests, not doctors. If in doubt, they expected cadaveric spots and other signs of decomposition. With the development of medicine, it became clear that death is not an event, but a rather lengthy process. At first, those whose heart stopped were considered dead. Then death was linked to the cessation of brain activity. But questions still remain.
First of all, the problem is that the medical point of view often contradicts our everyday ideas. According to Stuart Youngner, director of the Center for Biomedical Ethics in Cleveland, Ohio, brain death is just a ploy to allow transplantologists to write down as dead a person whose heart is still beating and most organs are still functioning, suitable for transplant.
Meanwhile, artificial respiration devices are able to support the work of the heart and lungs almost indefinitely. Vaughn, for example, the former prime minister of Israel has been in a state of clinical death for several years.
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But how long should you “pump oxygen” into a corpse? Does the patient still have one chance to survive? At what point is it already possible to "turn off" the deceased?
Physicians need to know the exact answers to these and many other similar questions, so as not to waste energy, time and resources that may be needed by a patient who can still be saved.
From these positions, the concept of brain death looks the most correct. As soon as activity inside the brain and in its trunk ceases, a person can no longer regain consciousness. And without outside interference, the body dies quickly.
A brain-dead patient is a good donor because his heart is still beating. As soon as it stops, death soon goes so far that the kidneys are the only organs that can be transplanted. Obviously, from such considerations, most technologically developed countries have legalized the criterion of brain necrosis. However, some states are still resisting.
One of the reasons is insufficient knowledge of the problem, even by doctors.
Charles McCluskey, executive director of LifeQuest Transplant Center in Gainesville, Florida, says: “When the brain dies, it breaks apart, and all activity stops. And yet, some doctors still believe that the feeling of pain can persist there and that it is within their power to bring back a person with a dead brain to life.
True, no one has yet been able to return from the other world after the death of the brain. Where patients seemed to be revived, the diagnosis of brain death was always misdiagnosed. Because sometimes even doctors confuse brain death with a coma - when a person is unconscious, but can still recover.
Yet brain death may not even mean that the patient is unconscious. Basil Matta and Peter Young, anesthesiologists at the Addenbrook Clinic in Cambridge, recently published an article calling for anesthetics of brain-dead patients before proceeding with organ removal.
Even though patients with a dead brain stem do not feel pain, they may still have spinal cord-driven reflex responses, they point out. And some potential donors are spinning on the operating table, the incisions cause their heart palpitations and high blood pressure, which greatly interferes with the work of surgeons and makes them nervous.
However, Youngner predicts that as organ shortages grow, the notion of the boundary of death will become increasingly blurred. The fact is that in the United States alone, the number of patients awaiting transplantation has more than tripled in recent years. At the same time, the number of organ transplants from dead and living donors grew much more slowly - from 15,000 to 22,000 over the same period.
Children's organs are missing the most. Between a third and half of children who need a transplant die before their turn. This has already forced the US authorities to consider using organs of questionable origin.
Not bad donors are babies with anencephaly. They have only the brain stem functioning, but not its cortex. Therefore, they rarely last more than a few hours or days. Back in 1994, the American Medical Association's Ethics and Jurisprudence Council ruled organ removal in infants with anencephaly was ethically acceptable.
Many are still worried about the real danger of misdiagnosis. In 1996, Keith Andrews, who was then at the Royal Neurodynamic Hospital, published an article in the British Medical Journal, where he and colleagues analyzed the diagnoses of forty patients who were in the hospital between 1992 and 1995. Scientists found that in seventeen cases, the diagnosis of death was erroneous.
Therefore, today physicians are pinning their hopes on the possibility of organ transplantation from genetically modified animals, as well as on new technologies for growing tissues and organs. Back in 2001, Fred Gage of the Salk Institute in La Jolla, California, and his colleagues announced that they were able to grow cells from tissue taken from a cadaver.
Scientists believe that the day will come when nerve cells for transplantation can be taken from dead donors, and not from embryonic tissues, as is happening now. These transplants could help millions of people suffering from conditions such as Parkinson's and Huntington's.
Even better, if we learn to grow certain organs from the cells of the patient himself. Let's say they took several cells from the heart of a person who doesn't have it today, so tomorrow it will probably fail. And in those few weeks, while his vital activity was supported by an artificial heart, a new "pump" was grown for the patient, to replace the stagnant one. The first successes on this path have already been made.