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Traditionally, death was defined as the cessation of all body functions, including respiration and heartbeat. Since it became possible to revive some people after a period without respiration, heartbeat, or other visible signs of life, as well as to maintain respiration and blood flow artificially using life support treatments, an alternative definition for death was needed. In recent decades, the concept of "brain death" has emerged. By brain death criteria, a person can be pronounced clinically dead even if the heart continues to beat due to life support measures. It should be noted that — in direct contradiction to media reports as regards certain current events — such a person is not "technically alive."
A brain dead individual has no electrical activity and no clinical evidence of brain function on neurologic examination (no response to pain, no cranial nerve reflexes ( pupillary responseIn medicine, pupil constriction (also known as the pupillary reflex is reduction of pupil size. It is the normal response of the pupil of the eye to light and dependent on the function of the optic nerves and oculomotor nerves. It is also important in acc (fixed pupils), oculocephalic reflex , corneal reflex es), and no spontaneous respirations). It is important to distinguish between brain death and states that mimic brain death (eg. barbiturateBarbiturates are drugs that acts as central nervous system (CNS) depressants, and by virtue of this they produce a wide spectrum of effects, from mild sedation to anesthesia. Some also are used as anticonvulsants. Barbiturates are derivatives of barbituri intoxicationdrunkenness Intoxication is an impaired mental and physical state caused by drinking alcoholic beverages or taking narcotic drugs. Sometimes, people in this impaired state act irresponsibly because of reduced inhibitions. The term intoxication is typicall, alcoholIn general usage, alcohol (from Arabic al-khwl , or al-ghawl ) refers almost always to ethanol, also known as grain alcohol and often to any beverage that contains ethanol (see alcoholic beverage . This sense underlies the term alcoholism ( addiction to a intoxication, sedativeA sedative is a drug that depresses the central nervous system (CNS), which causes calmness, relaxation, reduction of anxiety, sleepiness, slowed breathing, slurred speech, staggering gait, poor judgment, and slow, uncertain reflexes. Sedatives may be ref overdose, hypothermiaHypothermia is a medical condition in which the victim's core body temperature has dropped to significantly below normal and normal metabolism begins to be impaired. This begins to occur when the core temperature drops below 35 degrees Celsius (95 degrees, hypoglycemiaHypoglycemia is a medical term referring to a pathologic state produced and usually defined by a lower than normal amount of sugar ( glucose) in the blood. The term hypoglycemia literally means low blood sugar. Hypoglycemia can produce a variety of sympto, coma or chronic vegetative states). Some comatose patients can recover, and some patients with severe irreversible neurologic dysfunction will nonetheless retain some lower brain functions such as spontaneous respiration.
In a brain dead individual, the brain tissue itself is necrotic (dead). Conditions leading to brain death result in swelling of brain tissue and a rise in intracranial pressure, eventually shutting off all blood flow within the skull. Although some have proposed that loss of neo-cortical function should be termed "brain death", the term as used clinically includes loss of both cortex and brainstem function. Thus anencephaly, in which there is no higher brain present, is generally not considered brain death, although it is certainly an irreversible condition in which it may be appropriate to withdraw life support.
Note that brain electrical activity can stop completely, or apparently completely (a "flat EEG") for some time in deep anaesthesia or during cardiac arrest before being restored: brain death refers only to permanent cessation of electrical activity. Numerous people who have experienced such "flat line" experiences have reported near-death experiences, the nature of which is controversial.
It is presumed that a permanent stoppage of electrical activity indicates the end of consciousness. Those that view that only the neo-cortex of the brain is necessary for consciousness, however, sometimes argue that only electrical activity there should be considered when defining death. In many cases, especially when elevated intracranial pressure prevents blood flow into the skull, the entire brain is nonfunctional; however, some injuries may affect only the neo-cortex.
The diagnosis of brain death needs to be made quite rigorously to be certain the condition is truly irreversible. Legal criteria vary from place to place, but generally require neurologic exams by two independent physicians showing complete absence of brain function, and may include two isoelectric (flat-line) EEGs 24 hours apart. The Uniform Determination Of Death Act in the United States is an attempt to standardize criteria. The patient should have a normal temperature and be free of drugs that can suppress brain activity if the diagnosis is to be made on EEG criteria. Alternatively, a radionuclide cerebral blood flow scan that shows complete absence of intracranial blood flow can be used to confirm the diagnosis without performing EEGs.
Most organ donation for organ transplantation is done in the setting of brain death. Consent from family members is required in most nations (except, for instance, in Belgium, where every citizen is automatically an organ donor, unless you get a special attest stating that you are not an organ donor), and the non-living donor is kept on ventilator support until the organs have been surgically removed. If a brain dead individual is not an organ donor, ventilator and drug support is discontinued and cardiac death is allowed to occur.
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