Beating heart cadaver

A beating heart cadaver is a body that is pronounced dead in all medical and legal definitions, connected to a medical ventilator, and retains cardio-pulmonary functions. This keeps the organs of the body, including the heart, functioning and alive.[1] As a result, the period of time in which the organs may be used for transplantation is extended. The heart contains pacemaker cells that will cause the heart to continue beating even when a patient is brain-dead. Other organs in the body do not have this capability and need the brain to be functioning to send signals to the organs to carry out their functions. A beating heart cadaver requires a ventilator to provide oxygen to its blood, but the heart will continue to beat on its own even in the absence of brain activity.[2] This allows organs to be preserved for a longer period of time in the case of a transplant or donation. A small number of cases in recent years indicate that it can also be implemented for a brain-dead pregnant woman to reach the full term of her pregnancy.[2] There is an advantage to beating heart cadaver organ donation because doctors are able to see the vitals of the organs and tell if they are stable and functioning before transplanting to an ailing patient.[3] This is not possible in a donation from someone pronounced dead.

History

The observed phenomena of lifelike qualities after death is not a new concept. In René Descartes' Discourse on the Method, he notes that decapitated animals move and display characteristics of a living body a few seconds after decapitation which was published in 1637.[4] This continued into the French Revolution where it was observed that people who had been beheaded showed movements in facial muscles and hearts could continue to beat for almost an hour past the time of beheading.[5] The guillotine in some cases did not completely sever head from body. In 1875 an examiner named Pierre Jean Cabanis was assigned the duty of making sure a body was truly dead.[4] There were also stories involving beheadings where the victims would stand up and walk around before falling dead. The ambiguity around brain death and true death has followed it to present day. In an effort to clarify some of these gray areas, the Harvard Medical Committee developed criteria for identifying a body as dead in 1968.[4][5] These criteria required patients to be completely unaware and unresponsive to external stimuli, have no spontaneous muscle movements, and exhibit no reflexive response even when manipulated. They also required that an electroencephalography (EEG) show no signs of activity.[4] The purpose of this report was to encourage physicians to distinguish brain death and irreversible coma from a persistent vegetative state where the patient still has some awareness and cycles through sleep and wakefulness.[6]

In 1971 a similar Minnesota criteria was published eliminating the EEG, repeating the exam after 12 hours, a severe lesion in the brain, and increasing the duration of the apnea test to four minutes rather than Harvard's three minute guideline. Other slight changes in the next decades included the United Kingdom's decision to eliminate the repetition of the exam and change from a duration of the apnea test to specified levels of CO2 in 1976.[5] Later, in 1981 the President's Commission reinstated the apnea test and the repeat exam. In a study done in 1989, only 35% of 195 physicians and nurses involved in organ procurement polled knew brain death criteria. These were not the same nurses and physicians who diagnose brain death. Presently, there is hot debate over the protocol for diagnosing someone as brain dead due to widespread disinformation and misinformation on the internet. [7]

The American Academy of Neurology created a prerequisite and neurological clinical assessment to be used as guidelines for determining brain death published in 2010.[6] To be considered for brain death the body must have a determinant cause of coma, have normal systolic blood pressure, and pass two neurological tests. These neurological assessments commonly consist of an apnea test, reflex tests where the body is manipulated or exposed to a stimulus and does not react, or be in a coma where there is complete unresponsiveness.[6] Cerebral angiography, electroencephalography, transcranial doppler ultrasonography, and cerebral scintigraphy are some of the tests that are used to test if there is any significant brain activity.[6]

Care

Caring for a beating heart cadaver is similar to caring for a living patient. Since the brain has stopped functioning, the hormone levels and blood pressure must be regulated by intensive care unit (ICU) personnel.[8] The protocol for preserving the cadaver aims to prevent infection and maintain adequate oxygenation of tissue.[9] The cadaver's status must be continuously monitored, so that ICU staff can prevent organ failure or quickly operate to save threatened organs.[8]

Organ recovery

A beating heart cadaver is kept alive in order to keep its organs from decaying before they can be transplanted. Surgeons will remove the organs, one after the other, and have them transferred to the recipients' treating teams.[1] The entire recovery process is usually completed within four hours.[9] This process was formerly known as an "organ harvest", but the name has since changed to the milder "organ recovery".[1] Many organs can be extracted, and many lives can be saved by one body. The bodies are generally those of organ donors, who have either given first-person consent to become an organ donor, presumptive consent by not explicitly declining to donate[10] or whose legal next-of-kin makes the decision to donate.[11] Some donated organs are taken from non-heart-beating donors.[12] Organs from brain deaths, however, have a better success rate, and currently most organ donation is from these deaths.[13]

How long the brain-dead person is kept on the ventilator may vary depending on the availability of surgical teams and the wishes of the family of that brain-dead person. An anesthesiologist is regularly present at organ donation surgical procedures, not for pain, but to monitor the vital signs and administer medications to optimize organ harvest. [14] Due to the results of the apnea test if a person lacks the brain function to breathe unassisted, it is concluded that it would also lack the brain function to relay the sensation of pain.[14] The anesthesiologist also ensures that muscle spasms or reflexes do not occur during the procedure. Though the brain may be dead, the pathway that reflexes follow does not pass from the stimulus in the body to the brain. Instead the spinal cord coordinates the knee-jerk reactions of reflexes including pulling back from the pain of putting a hand in an open flame or jerking away from an invasive incision. When the brain is dead these pathways remain intact and the anesthesiologist is present to ensure that these reactions do not complicate the procedure.[14]

Brain death and pregnancy

Pregnancy can be prolonged after brain death. It is then possible to deliver the baby by means of caesarian section.[15] Cadavers have been reported to support a fetus for a period of 107 days. After delivering the baby, some cadavers have subsequently become organ donors.[16] Since 1981 there have been 22 recorded instances of keeping a mother declared brain dead in a beating heart cadaver state until the baby is delivered.[2]

A review of 11 of these unique circumstance pregnancies was conducted in 2000. Four of these cases involved a persistent vegetative state of the mother and in 7 maternal brain death was diagnosed.[17] The women that underwent these gestation periods all delivered preterm an average of 30.5 weeks, where a normal pregnancy is around 35 weeks for full term.[17] The mothers were observed to have severe hypotension once in the brain dead or vegetative state and in all but one case the baby was delivered by cesarian section. It has also been found that by the 24th week of pregnancy intensive care is not as necessary and the mother is more stable than treatment occurring before the 24th week.[17] Common complications involved inability to regulate temperature which is treated with heating and cooling blankets, as well as failure of the endocrine system which is important in maintaining a stable fetal environment.[17] Following the delivery of the baby, organs of the mother are harvested as well.[16]

From an ethical perspective the family and next of kin are often involved in the decision to terminate or prolong the pregnancy. This can be a difficult decision given the level of care required to keep the mothers living for the duration of their gestation which can vary. Intensive care of a vegetative state patient is not usually advised due to the dismal chances of recovery, but in the case that the fetus could survive this care is often justified and administered at the discretion of the family.[14][17] Intense counseling and advisement by physicians and neonatal experts often accompanies these rare situations.[12]

Ethical debate

Brain death is defined as irreversible cessation of all functions of the entire brain, including the brain stem: coma (with a known cause), absence of brainstem reflexes, and apnea. When doctors take away ventilation systems and patients fail to breathe, move, or show any signs of arousal on their own they are considered brain dead.[14] This test is called an apnea test. The ventilator is taken away and is reconnected only if the person decided to be an organ donor. This definition can create some cognitive dissonance because not responding to stimulation may show a problem with the central nervous system, yet when someone has a beating heart and lungs that will still function with the help of a ventilator it is difficult for some to accept as death. Brain death patients have characteristics of the living and the dead.[3]

Social issues

Organ recovery from beating heart cadavers has remained ambiguous to the public. There is a guideline for organ transplantation consisting of two parts. It states that organ donors must be dead before removing the organs, and removing the organs is not the cause of death.[18] This clause is in place to ensure that organ donation is not exploited to use people purely as a means to an end. However, many believe that even with these guidelines in place the protocol for organ donation still has room for criticism. Negative reviews from public and medical personnel on this subject tend to stem from a lack of understanding of what it means to be considered brain dead and how these decisions are made.[19] One social issue that is commonly brought up is the potential for conflict of interest for the medical team examining the body.[19] Another issue raising concerns in the organ donation by beating heart cadaver field is the administration of drugs to the patient that prevent clotting prior the donation procedure. These drugs are not beneficial to the patient and are intended solely to help the recipient of the organs.[18] To alleviate some of these social concerns, there has been push for a standard in determining death and creating a normalized system for transplantation in these patients.[19]

Religious and cultural differences

From a religious standpoint, the encouragement of organ donation or acceptance may vary. The Catholic church with input from Pope John Paul II, identified transplantation from beating heart cadavers or living subjects as acceptable if there are no added risks to the donor.[20] This has been widely debated in Japan where the first heart transplant took place in 1968 and the patient died a few months after the procedure.[21] Since then, more transplantation procedures have taken place but it is still a controversial subject. Transplantation in naturalist religions and cultures such as Native Americans, Buddhists, and Confucianists tend to dissuade the use of living donors and transplantation.[20] The body is idealized as a home for a soul and the organs belonging to a person are considered perverse if utilized by another person. No religion specifically outlaws the use of beating heart cadavers or prefers them to non beating heart cadavers.[20][21] Western cultures more widely accept the use of transplantation by beating heart cadavers than more conservative cultures.[20] The main concern of many religions and cultures is ensuring the body is not objectified or disrespected in harvesting and transplantation of organs.[20]

Cultural references

Award-winning Canadian writer Colleen Murphy's play Beating Heart Cadaver had its premiere in the United Kingdom on 3 April 2011 at the Finborough Theatre, London.

See also

References

  1. ^ a b c Roach, Mary. Stiff: the Curious Lives of Human Cadavers. New York: W.W. Norton &, 2003. Print.
  2. ^ a b c Teresi, Dick (2012). The Undead: Organ Harvesting, the Ice-Water Test, Beating-Heart Cadavers - How Medicine is Blurring the Line Between Life and Death. New York: Pantheon Books. pp. 89–92. ISBN 978-0-375-42371-0.
  3. ^ a b Zamperetti, N (2003). "Defining death in non-heart beating organ donors". Journal of Medical Ethics. 29 (3): 182–185. doi:10.1136/jme.29.3.182. ISSN 0306-6800. PMC 1733717.
  4. ^ a b c d Saposnik, Gustavo; Basile, Vincenzo S.; Young, G. Bryan (2014). "Movements in Brain Death: A Systematic Review". Canadian Journal of Neurological Sciences. 36 (2): 154–160. doi:10.1017/S031716710000651X. ISSN 0317-1671.
  5. ^ a b c Daroff, R. (2007). "The Historical Evolution of Brain Death from Former Definitions of Death: the Harvard Criteria to the Present". The Signs of Death. 110: 217–221.
  6. ^ a b c d Wijdicks F, Valrelas P, Gronseth G, Greer D (2010). "American Academy of Neurology Guidelines for Brain Death Determination". Neurology. 74: 1911–1918.
  7. ^ Ward, S (2015). "Beating Heart Cadavers". Georgia Right to Life. Retrieved 20 April 2016.
  8. ^ a b Roach, p. 170.
  9. ^ a b "The beating heart donor". British Organ Donor Society. Retrieved 4 March 2010.
  10. ^ "Are we in control of our own decisions?". So I want to show you some cognitive illusions, or decision-making illusions, in the same way. And this is one of my favorite plots in social sciences. It's from a paper by Johnson and Goldstein. And it basically shows the percentage of people who indicated they would be interested in giving their organs to donation....Turns out the secret has to do with a form at the DMV. And here is the story. The countries on the left have a form at the DMV that looks something like this. Check the box below if you want to participate in the organ donor program. And what happens? People don't check, and they don't join. The countries on the right, the ones that give a lot, have a slightly different form. It says check the box below if you don't want to participate. Interestingly enough, when people get this, they again don't check -- but now they join.
  11. ^ Bell, Diane (27 February 2010). "Her donated organs changed lives of many". The San Diego Union Tribune. Retrieved 4 March 2010.
  12. ^ a b "Brain Death or NHBD – Important Distinction". physiciansforlife.org. Archived from the original on 14 November 2014. Retrieved 4 March 2010.
  13. ^ Whitlock, Jennifer (6 April 2016). "Organ Donation Types". verywell.com. Retrieved 13 December 2016.
  14. ^ a b c d e Gross, Terry. "Blurring the Lines between Life and Death". National Public Radio. Retrieved 23 February 2016.
  15. ^ Bernstein, I. M.; Watson, M; Simmons, G. M.; Catalano, P. M.; Davis, G; Collins, R (1989). "Maternal brain death and prolonged fetal survival". Obstetrics and gynecology. 74 (3 Pt 2): 434–7. PMID 2761925.
  16. ^ a b Powner, DJ; Bernstein, IM (April 2003). "Extended somatic support for pregnant women after brain death". Critical Care Medicine. 31 (4): 1241–9. doi:10.1097/01.ccm.0000059643.45027.96. PMID 12682499.
  17. ^ a b c d e Feldman, D (2000). "Irreversible Maternal Brain Injury During Pregnancy: A Case Report and Review of Literature". Obstetrical & Gynecological Survey.
  18. ^ a b Potts, Michael (2007). "Truthfulness in transplantation: non-heart-beating organ donation". Philosophy, Ethics, and Humanities in Medicine. 2 (1): 17. doi:10.1186/1747-5341-2-17. ISSN 1747-5341. PMC 2000872.
  19. ^ a b c Bastami, Sohaila; Matthes, Oliver; Krones, Tanja; Biller-Andorno, Nikola (2013). "Systematic Review of Attitudes Toward Donation After Cardiac Death Among Healthcare Providers and the General Public". Critical Care Medicine. 41 (3): 897–905. doi:10.1097/CCM.0b013e31827585fe. ISSN 0090-3493. PMID 23328261.
  20. ^ a b c d e Bruzzone, P. (2008). "Religious aspects of organ transplantation". Transplantation Proceedings. 40: 1064–1067.
  21. ^ a b Bowman, K.; Richard, S. (2003). "Culture, brain death, and transplantation". Progress in Transplantation. 13: 211–217.
1999 Governor General's Awards

The winners of the 1999 Governor General's Literary Awards were announced by Jean-Louis Roux, chairman, and Shirley Thomson, director of the Canada Council for the Arts, at a press conference held on November 16 at the National Library of Canada. Each winner received a cheque for CA$10,000.

Algor mortis

Algor mortis (Latin: algor—coldness; mortis—of death), the second stage of death, is the change in body temperature post mortem, until the ambient temperature is matched. This is generally a steady decline, although if the ambient temperature is above the body temperature (such as in a hot desert), the change in temperature will be positive, as the (relatively) cooler body acclimates to the warmer environment. External factors can have a significant influence.

The term was first used by Dowler in 1849. The first published measurements of the intervals of temperature after death were done by Dr John Davey in 1839.

BHC

BHC can refer to:

Balochistan High Court, a high court in Quetta, Balochistan, Pakistan

Bank holding company, company with significant ownership of one or more banks

Barron Hilton Cup, a glider competition

Beaconhills College, a school in Victoria, Australia

Beating Heart Cadaver, a human body that, after having been declared brain-dead, is attached to a medical ventilator in order to preserve organs for organ transplantation

Benign hereditary chorea, a neurological disorder

Benzene hexachloride (disambiguation), different chemicals

Bergischer HC, a German team handball club

British high commission

Beverly Hills Cop (film series), a movie franchise starring Eddie Murphy

Beverly Hills Chihuahua

BHC Communications, a broadcast holding company, held by Chris-Craft Industries

British Home Championship, an annual football competition in the United Kingdom

British Honduras Constabulary, a former police force in Belize

British Hovercraft Corporation, a former hovercraft manufacturer of the United Kingdom

Business History Conference, an organization that focuses on business history and the environment in which businesses operate

Colleen Murphy

Colleen Murphy (born 1954 in Rouyn-Noranda, Quebec) is a Canadian screenwriter, film director and playwright. She is best known for works including her plays The December Man, which won the Governor General's Award for English-language drama at the 2007 Governor General's Awards, and Beating Heart Cadaver, which was a shortlisted nominee for the same award at the 1999 Governor General's Awards, and the film Termini Station, for which she garnered a Genie Award nomination for Best Original Screenplay at the 11th Genie Awards.

Dead on arrival

Dead on arrival (DOA), also dead in the field and brought in dead (BID), indicates that a patient was found to be already clinically dead upon the arrival of professional medical assistance, often in the form of first responders such as emergency medical technicians, paramedics, or police.

In some jurisdictions, first responders must consult verbally with a physician before officially pronouncing a patient deceased, but once cardiopulmonary resuscitation is initiated, it must be continued until a physician can pronounce the patient dead.

Death hoax

A death hoax is a deliberate or confused report of someone's death that turns out to be incorrect and murder rumors. In some cases it might be because the person has intentionally faked death.

Death messenger

Death messengers, in former times, were those who were dispatched to spread the news that an inhabitant of their city or village had died. They were to wear unadorned black and go door to door with the message, "You are asked to attend the funeral of the departed __________ at (time, date, and place)." This was all they were allowed to say, and were to move on to the next house immediately after uttering the announcement. This tradition persisted in some areas to as late as the mid-19th century.

Death rattle

Terminal respiratory secretions (or simply terminal secretions), known colloquially as a death rattle, are sounds often produced by someone who is near death as a result of fluids such as saliva and bronchial secretions accumulating in the throat and upper chest. Those who are dying may lose their ability to swallow and may have increased production of bronchial secretions, resulting in such an accumulation. Usually, two or three days earlier, the symptoms of approaching death can be observed as saliva accumulates in the throat, making it very difficult to take even a spoonful of water. Related symptoms can include shortness of breath and rapid chest movement. While death rattle is a strong indication that someone is near death, it can also be produced by other problems that cause interference with the swallowing reflex, such as brain injuries.It is sometimes misinterpreted as the sound of the person choking to death, or alternatively, that they are gargling.

Death trajectory

Death trajectory refers to the pattern of dying when a patient is given a projected death date with limited or no medical recourse for the remaining existence of the individual's life. The death trajectory is dependent on the cause of death, whether it is sudden death, chronic illness, or the steady decline in health due to senescence (aging). Death trajectory is analyzed in two separate aspects: duration and shape. Duration refers to the period of time a patient has to live, which can be anywhere from imminent death to several months. Shape refers to how that duration is then graphed. In other words, the shape is "the course of dying, its predictability, and whether death is expected or unexpected".

Dying trajectories were first studied in the 1960s by two researchers, Barney Glaser and Anselm Strauss, in an attempt to understand the end of human life from different ailments, including cancer.

Dignified death

Dignified death is a somewhat elusive concept often related to suicide. One factor that has been cited as a core component of dignified death is maintaining a sense of control. Another view is that a truly dignified death is an extension of a dignified life. There is some concern that assisted suicide does not guarantee a dignified death, since some patients may experience complications such as nausea and vomiting. There is some concern that age discrimination denies the elderly a dignified death.

Dysthanasia

In medicine, dysthanasia means "bad death" and is considered a common fault of modern medicine.Dysthanasia occurs when a person who is dying has their biological life extended through technological means without regard to the person's quality of life. Technologies such as an implantable cardioverter defibrillator, artificial ventilation, ventricular assist devices, and extracorporeal membrane oxygenation can extend the dying process.

Dysthanasia is a term generally used when a person is seen to be kept alive artificially in a condition where, otherwise, they cannot survive; sometimes for some sort of ulterior motive. The term was used frequently in the investigation into the death of Formula One driver Ayrton Senna in 1994.

Lazarus sign

The Lazarus sign or Lazarus reflex is a reflex movement in brain-dead or brainstem failure patients, which causes them to briefly raise their arms and drop them crossed on their chests (in a position similar to some Egyptian mummies). The phenomenon is named after the Biblical figure Lazarus of Bethany, whom Jesus raised from the dead in the Gospel of John.

Megadeath

Megadeath (or megacorpse) is one million human deaths, usually caused by a nuclear explosion. The term was used by scientists and thinkers who strategized likely outcomes of all-out nuclear warfare.

Necronym

A necronym (from the Greek words νεκρός, nekros, "dead" and ὄνομα ónoma, "name") is a reference to, or name of, a person who has died. Many cultures have taboos and traditions associated with referring to such a person. These vary from the extreme of never again speaking the person's real name, often using some circumlocution instead, to the opposite extreme of commemorating it incessantly by naming other things or people after the deceased.

For instance, in some cultures it is common for a newborn child to receive the name (a necronym) of a relative who has recently died, while in others to reuse such a name would be considered extremely inappropriate or even forbidden. While this varies from culture to culture, the use of necronyms is quite common.

Necrophobia

Necrophobia is a specific phobia which is the irrational fear of dead things (e.g., corpses) as well as things associated with death (e.g., coffins, tombstones, funerals, cemeteries). With all types of emotions, obsession with death becomes evident in both fascination and objectification. In a cultural sense, necrophobia may also be used to mean a fear of the dead by a cultural group, e.g., a belief that the spirits of the dead will return to haunt the living.Symptoms include: shortness of breath, rapid breathing, irregular heartbeat, sweating, dry mouth and shaking, feeling sick and uneasy, psychological instability, and an altogether feeling of dread and trepidation. The sufferer may feel this phobia all the time. The sufferer may also experience this sensation when something triggers the fear, like a close encounter with a dead animal or the funeral of a loved one or friend. The fear may have developed when a person witnessed a death, or was forced to attend a funeral as a child. Some people experience this after viewing frightening media.The fear can manifest itself as a serious condition. Treatment options include medication and therapy.The word necrophobia is derived from the Greek nekros (νεκρός) for "corpse" and the Greek phobos (φόβος) for "fear".

Pallor mortis

Pallor mortis (Latin: pallor "paleness", mortis "of death"), the first stage of death, is an after-death paleness that occurs in those with light/white skin.

Post-mortem interval

Post-mortem interval (PMI) is the time that has elapsed since a person has died. If the time in question is not known, a number of medical/scientific techniques are used to determine it. This also can refer to the stage of decomposition of the body.

Promession

Promession is an idea of how to dispose human remains by way of freeze drying. The concept of promession was developed by Swedish biologist Susanne Wiigh-Mäsak, who derived the name from the Italian word for "promise" (promessa). She founded Promessa Organic AB in 1997 to commercially pursue her idea. The company was liquidated 2015 without being able to produce a functioning facility. The idea of promession is questioned and not a functional method according to critics.

Skeletonization

Skeletonization refers to the final stage of decomposition, during which the last vestiges of the soft tissues of a corpse or carcass have decayed or dried to the point that the skeleton is exposed. By the end of the skeletonization process, all soft tissue will have been eliminated, leaving only disarticulated bones. In a temperate climate, it usually requires three weeks to several years for a body to completely decompose into a skeleton, depending on factors such as temperature, humidity, presence of insects, and submergence in a substrate such as water. In tropical climates, skeletonization can occur in weeks, while in tundra areas, skeletonization may take years or may never occur, if subzero temperatures persist. Natural embalming processes in peat bogs or salt deserts can delay the process indefinitely, sometimes resulting in natural mummification.The rate of skeletonization and the present condition of a corpse or carcass can be used to determine the time of death.After skeletonization, if scavenging animals do not destroy or remove the bones, acids in many fertile soils take about 20 years to completely dissolve the skeleton of mid- to large-size mammals, such as humans, leaving no trace of the organism. In neutral-pH soil or sand, the skeleton can persist for hundreds of years before it finally disintegrates. Alternately, especially in very fine, dry, salty, anoxic, or mildly alkaline soils, bones may undergo fossilization, converting into minerals that may persist indefinitely.

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