Sunday, April 12, 2015

Brain death

"The controversy about the philosophical and biological status of BD is more complex than this, and it's not possible to do justice to the two sides of the debate here. But the fact that controversy persists, more than 40 years after the concept of brain death was first formally proposed, is enough to suggest that the biological and philosophical status of brain death is at least open to intellectually respectable debate."



  1. See: Breningstall GN. Defining death: when physicians and family differ. Pediatr
    Neurol. 2014 Oct;51(4):476-7.

  2. "Because many countries, even wealthy countries, lack procedures similar to the American Academy of Neurology’s criteria, Greer thinks that in some countries, it is more likely that someone may be declared brain dead when they are, in fact, alive.

    'Let’s say they don’t require that the pupil response be absent, or the gag reflex be absent,' said Greer. 'Those are things that measure brain functioning at a very rudimentary level, so unless those are accounted for, physicians may be misdiagnosing people, which would be the worst thing possible.'

    The misdiagnosed patients would almost certainly not be recoverable already, said Greer, but could still have brain-functioning capacity. Misdiagnosis, then, crosses a 'very clear line' by cutting off support for the patient before he or she is actually dead."


  3. A brain dead Nebraska woman was kept on life support for nearly eight weeks so the baby she was carrying could survive, medical officials said.

  4. New Jersey Law parallels the California criteria for brain death as they both stem from the UDDA, but New Jersey recognizes the First Amendment right to freedom of religion as well as the Fourth and 14th amendments, which form the basis for medical privacy and individual rights to challenge the termination process. New Jersey’s exception was the result of efforts by a religious leaders who felt individuals should retain the right over this most important of life’s decisions as cardio-pulmonary death, not brain death, was in accordance with their religious teachings and faith.

    Therefore, New Jersey law has the following exception to brain death incorporated into its brain death statute: “26:6A-5. Death not declared in violation of individual’s religious beliefs. The death of an individual shall not be declared upon the basis of neurological criteria ... when the licensed physician authorized to declare death, has reason to believe, on the basis of information in the individual’s available medical records, or information provided by a member of the individual’s family or any other person knowledgeable about the individual’s personal religious beliefs that such a declaration would violate the personal religious beliefs of the individual. In these cases, death shall be declared, and the time of death fixed, solely upon the basis of cardio-respiratory criteria.”

    Many people have labeled people who have challenged a brain death diagnosis as “crazy, stupid, ignorant, etc.” If this is true, the 8.938 million people in New Jersey who have this right must be the largest assembled mass of stupid people in the world...

    I can tell you, as you will soon hear, that a brain death diagnosis made in the Bay Area recently at a well-known hospital made by four members of the hospital’s medical staff was recently overturned by two independent neurologists who conducted an examination pursuant to a court order.


  5. Taylor remained unresponsive for a week. Then, in the early morning hours of Sept. 17, she suffered a brain hemorrhage.

    Doctors and nurses fought to save Taylor's life. But at the end of a grueling session, Taylor's brain sank part way into her spinal canal.

    No one comes back from that, the doctors told Taylor's mother, Stacy, and her father, Chuck Hale.

    Nothing more could be done. Their daughter was brain dead. It was time to make arrangements to take her off life support and discuss organ donation...

    Later that afternoon, doctors turned off the life support that had been helping her breath since the accident...

    And then, something unexpected happened: Taylor struggled to take a breath under her own power.

    They reconnected life support. As the day went on, Taylor's brain activity began to increase. Her eyes fluttered. She made mumbling noises, trying to talk.

    And finally, Taylor Hale, considered brain dead by science, awoke from her coma.

  6. I looked at my Mother-in-Law and asked, “What did she tell you?”

    This is the story as my Mother-in-Law remembers it…

    When they first got married, they went on their honeymoon to a very beautiful Island. They went bungee jumping and something went terribly wrong. She crashed into a rock and broke her back and neck, and was unconscious. There were no adequate hospitals nearby, so they chartered a plane back to New York. The doctors there put her through many tests and came back with very bad news. She had broken almost every bone in her body and was absolutely brain dead. It was time for her new husband to say good bye. After a few months, her fingers and toes began to move. The doctor was quick to assure her husband that it means nothing, it is just reflexes. A few months later she woke up. After many more tests, the doctor informed them that although she far surpassed his expectations, it would not get better then this. She will never walk and never have children.

    She then told my Mother-in-Law, I came to Temecula today to tell you this. I walked into your son’s house, pregnant with my second child with one message. There is only One healer, and He is Hashem!!

  7. Re 5/14/15 8:51 entry above:

  8. Substantial differences in perceptions and practices of brain death exist worldwide. The identification of discrepancies, improvement of gaps in medical education, and formalization of protocols in lower-income countries provide first pragmatic steps to reconciling these variations. Whether a harmonized, uniform standard for brain death worldwide can be achieved remains questionable.

    Wahlster S, Wijdicks EF, Patel PV, Greer DM, Hemphill JC 3rd, Carone M, Mateen
    FJ. Brain death declaration: Practices and perceptions worldwide. Neurology. 2015
    May 5;84(18):1870-9.

    But as the WHO has found,2 formidable medical and societal barriers must be overcome before such consensus becomes possible.
    * Acceptance of brain death as death
    * Legal standards of death determination
    * Religious beliefs about death
    * Cultural norms about death
    * Requirements for organ donation
    * Knowledge deficits of professionals
    * Examination technical requirements
    * Availability and quality of ancillary tests

    Bernat, J. Is international consensus on brain death achievable? Neurology 2015 May 5;84(18):1878.

  9. We seek to change the conversation about brain death by highlighting the distinction between brain death as a biological concept versus brain death as a legal status. The fact that brain death does not cohere with any biologically plausible definition of death has been known for decades. Nevertheless, this fact has not threatened the acceptance of brain death as a legal status that permits individuals to be treated as if they are dead. The similarities between “legally dead” and “legally blind” demonstrate how we may legitimately choose bright-line legal definitions that do not cohere with biological reality. Not only does this distinction bring conceptual coherence to the conversation about brain death, but it has practical implications as well. Once brain death is recognized as a social construction not grounded in biological reality, we create the possibility of changing the social construction in ways that may better serve both organ donors and recipients alike...

    In any case, in the immediate aftermath of many news stories where bioethicists recited the dogma that brain death is biological death, it is telling that NBC News published a story claiming that “A 32-year-old Canadian woman who had been declared brain dead in December and kept on life support for six weeks died on Sunday soon after giving birth to a baby boy”[See 5/1/15 comment above]. Even after all of the careful coaching by bioethicists, sophisticated news services still seem to have a hard time believing that a baby can be born to a woman who has been dead for six weeks. So do we.

    See: Truog RD, Miller FG. Changing the conversation about brain death. Am J Bioeth. 2014;14(8):9-14.

  10. In our view, these and other commentators have ignored an important distinction between brain death as a biological phenomenon and as a legal status. For more than 200 years, the essential features of living organisms have been the subject of scientific investigation. At present, we understand life to be defined in terms of the capacity of organisms to use energy in maintaining a stable homeostatic internal environment and integrated functioning. When an organism loses this capacity, it has died. This definition applies across the biological spectrum, from single-celled organisms to complex plants and animals.

    The history of brain death reveals a persistent and continued failure to connect the concept of brain death with this biological understanding of life and death. The 1968 report from the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death proposed a definition of “irreversible coma” but provided no reason to consider patients in this condition to be actually dead...

    The scientific evidence is clear—in many cases, brain-dead patients are biologically alive. Nevertheless, there is good reason to maintain the widely accepted policy stance that those with a diagnosis of brain death are legally dead...

    This makes it reasonable to treat a patient who is brain dead as legally dead; the patient is as good as dead. Maintaining life support can be of no value for a person in an irreversible coma; nor can such a person be harmed or wronged by procuring their organs for transplantation, as long as valid consent has been obtained.

    Truog RD, Miller FG. The meaning of brain death: a different view. JAMA Intern
    Med. 2014 Aug;174(8):1215-6

  11. The fiction of brain death as death is not widely acknowledged or known by the public. Transparency is an important element in the responsible use of legal fictions, in order to avoid confusion about when it no longer makes sense to use the metaphor. The lack of transparency surrounding brain death may be unnecessarily confusing to those making decisions about organ donation, may compromise the validity of the consent that is obtained, and is vulnerable to challenge in lawsuits or the court of public opinion...

    One important step forward in the debate over brain death is to recognize and acknowledge the legal fiction of treating brain death as death. With Miller and Truog, I have argued for an acknowledged legal fictions approach. We call for the recognition that the brain dead are not dead but can be treated as such for legal purposes related to organ donation and the withdrawal of life-sustaining therapy.


  12. Jahi's heart has continued to beat on its own more than 60 million times since she was declared "brain dead." The doctors in Oakland Children's Hospital further declared that Jahi's heart would stop beating and that she would otherwise deteriorate. These predictions have not occurred. After the declaration of "brain death," the doctors and nurses referred to Jahi as "a dead body" and would not call her by her name. Jahi has been alive since her conception within her mother, and she remains alive today.

    Recently I visited Jahi in her home. Jahi is beautiful. The day that I visited Jahi she had on lip gloss like many teenagers. A picture of Jahi's hand joined with my hand is enclosed. Wristbands on both of us state "Jahi is alive" and "Prayer works."

    "Brain death" is not true death. Everyone declared "brain dead" has a beating heart, circulation, respiration and mutually interacting heart, liver, kidneys, intestine, salt and water balance, self-controlled body temperature and thousands of actions and reactions that can occur only in someone who is living and never in a cadaver. Healing continues in Jahi, like all living patients declared "brain dead."


  13. At first blush, the ATS guidelines appear to strike a cautious balance of patient autonomy, exercised by families as surrogates, and clinician judgement of best interest. The press release for the article quotes one of the authors, Douglas White, MD, as saying, "Clinicians should neither simply acquiesce to treatment requests that they believe are not in a patient's best interest, nor should they unilaterally refuse to provide treatment."

    But on closer inspection, the guidelines take a firm stance on which requests are open to debate. The guidelines assert that clinicians can refuse to provide treatment with no physiologic benefit, and can refuse requests for "legally proscribed" treatments, such as providing ongoing life support to a patient diagnosed as brain dead, in a state where brain death is recognized. This may seem obvious, but there has been an erosion of previously clear lines since the tragic and widely publicized case of Jahi McMath, the 13-year-old patient with anoxic brain injury who was kept alive at her family's request despite a diagnosis of brain death in California.


    Bosslet GT, Pope TM, Rubenfeld GD, Lo B, Truog RD, Rushton CH, Curtis JR, Ford DW, Osborne M, Misak CJ, Au DH, Azoulay E, Brody B, Fahy BG, Hall JB, Kesecioglu J, Kon AA, Lindell KO, White DB; American Thoracic Society ad hoc Committee on Futile and Potentially Inappropriate Care. An Official ATS/AACN/ACCP/ESICM/SCCM Policy Statement: Responding to Requests for Potentially Inappropriate Treatments in Intensive Care Units. Am J Respir Crit Care Med. 2015 May 15. [Epub ahead of print]

    There is controversy about how to manage requests by patients or surrogates for treatments that clinicians believe should not be administered.
    This multisociety statement provides recommendations to prevent and manage intractable disagreements about the use of such treatments in intensive care units.
    The recommendations were developed using an iterative consensus process, including expert committee development and peer review by designated committees of each of the participating professional societies (American Thoracic Society, American Association for Critical Care Nurses, American College of Chest Physicians, European Society for Intensive Care Medicine, and Society of Critical Care).
    Main Results:
    The committee recommends: (1) Institutions should implement strategies to prevent intractable treatment conflicts, including proactive communication and early involvement of expert consultants. (2) The term "potentially inappropriate" should be used, rather than futile, to describe treatments that have at least some chance of accomplishing the effect sought by the patient, but clinicians believe that competing ethical considerations justify not providing them. Clinicians should explain and advocate for the treatment plan they believe is appropriate. Conflicts regarding potentially inappropriate treatments that remain intractable despite intensive communication and negotiation should be managed by a fair process of conflict resolution; this process should include hospital review, attempts to find a willing provider at another institution, and opportunity for external review of decisions.

  14. See 5/14/15 8:51 am entry above

  15. LifeNews has chronicled many other occasions on which babies were born to mothers who were brain dead and kept alive at the time in order to save their lives.

    A baby was born in Hungary in December after a very rare circumstance in which his brain-dead mother was kept alive for three months so he could be born. As LifeNews has previously reported, in a case out of the United States from 2005, this kind of situation has occurred previously but is far from common.

    The case is not totally unique and another one like it occurred in Hungary in 2013.

    On life support for nearly three months in order to facilitate the birth of her child, Susan Torres, in August 2005, gave birth to a baby girl. Susan Anne Catherine Torres was born by Caesarean section two months premature and weighed just one pound and 13 ounces and measured 13.5 inches long.

    Torres, a researcher at the American National Institutes of Health, collapsed on May 7 and was rushed to hospital where she was diagnosed with stage four melanoma (cancer) and was declared brain dead, with no hope of recovery.

    Hospital physicians discovered the melanoma, treated nine years earlier, had recurred metastasized to her brain. The tumor then hemorrhaged, causing brain death.

    A mother of a two year-old son, Torres was 17 weeks pregnant at the time of her collapse. Doctors told her husband, Jason, that there was no hope of survival for his wife, but that they could possibly prevent their baby from dying if she was kept alive.

    Justin and Susan’s parents agreed doctors should do everything possible to save the couple’s child.

    Another such story involved a mother who was only eight weeks pregnant when she suffered a severe poly-substance drug overdose that nearly killed her. The doctors who treated her said that her body was deprived of oxygen for approximately four hours. The overdose combined with the lack of oxygen left brain damaged and she was put on life support at a local hospital.

    Immediately after the incident, the woman’s family was told that her baby would not survive and suggested that she be taken off life support. Thankfully, the maternal grandmother was against this proposition and said that her daughter would want her child to have a chance. Now the baby, named Isabella Hope, is doing well and has been adopted by a loving family.

    Unfortunately, some cases involving brain-dead pregnant women don’t turn out well because family members or medical professionals refuse to give the unborn child a chance and remove life-support even though there are two lives involved.

    For example, earlier this year a Texas hospital decided not to appeal a judge’s decision to allow a husband’s bid to remove his “brain dead” pregnant wife from life support, an action that would end the life of his own unborn child. The woman, Marlise Munoz, collapsed in her home from a blood clot in her lungs when she was 14 weeks pregnant with her second child.


  16. Re 5/1/15 above:

    Earlier this year, a miracle baby was born after doctors kept his brain dead mother “alive” long enough to give birth.

    Baby Angel weighed just 2 pounds and 16 ounces and Methodist Health System said a team of more than 100 doctors, nurses and staff were needed to help him make it out of his mother’s womb alive. But Baby Angel was almost never born.

    Angel’s 22-year-old mother Karla Perez had to be kept alive for 54 days to give doctors enough time to deliver him via Cesarian section without delivering him too prematurely, thereby causing his death. Tragically, Karla collapsed in her Nebraska home in February after she complained of sever headaches. later, doctors determined she suffered from a brain bleed.

    “Our team took a giant leap of faith,” Sue Korth, vice president and COO of Methodist Women’s Hospital, said in a statement Thursday announcing the successful procedure. “We were attempting something that not many before us have been able to do.”

    Now, little Baby Angel is finally heading home.

    Tuesday Angel, now four pounds heavier, was released from Methodist Women’s Hospital. Methodist Hospital spokesperson Claudia Bohn said in an update, “He is now over 6 pounds and I’m told is a good little eater!”


  17. Despite its widespread adoption, DDNC is hardly without legal and ethical controversy and criticism. It has been described as "at once well settled and persistently unresolved." The latest re-evaluation of the definition of death from a federal oversight perspective was from the U.S. President's Council on Bioethics. In its 2008 published report, the Council continued to endorse "total brain failure" as an appropriate criterion for declaring death. Further, it concluded that brain death remains both "biologically and philosophically defensible."

    Some remain critical, arguing that brain death is "seriously problematic" and that the legal definition of death does not correspond to a biological definition of death. But most acknowledge that "current practices can be justified ethically and legally." In short, despite some conceptual flaws, these critics see brain death as "too ingrained to abandon."…

    In formulating its holding, the court acknowledged earlier case law in New York when stating that "[i]f a person is dead, there is no life to be deprived of, with or without due process of law. From time immemorial, physicians have determined when persons are dead and have ceased giving medical treatment…. It is not a denial of due process to have physicians, rather than parents or next of kin or close friends, determine that death has occurred." In their final decision, the court extended the order restraining the hospital from discontinuing life support systems for 7 days to allow the family time to seek out a another facility willing to take the child….

    Still, Issac's mother and a court-appointed guardian argued that the hospital could not stop Issac's physiological support because parents have a constitutional right to make medical decisions for their children. They argued that because Issac's parents had not had those rights terminated, they possessed sole decision making authority with respect to Issac's medical care.(continued)

  18. (continuation)The court rejected this position stating that "with death, no parental decision making survives (save decisions regarding burial)." Instead, the court found that because the criteria for brain death were met, Issac was "legally dead" and therefore, the hospital had "no legal obligation to artificially maintain respiration, circulation or to render any other medical intervention or treatment." …

    In 2007, a high school student sustained head injuries while on a school ski trip. In a federal lawsuit filed against the hospital and the area organ procurement organization, the boy's parents alleged that they were asked to consent to organ donation even though death had not been determined and was not even imminent. Their claim included that had he been properly treated rather than "killed for his organs," he would have had a significant chance of recovery. Claims for battery, fraudulent misrepresentation, negligent misrepresentation, and medical malpractice were asserted. In late 2012, the parties settled these claims for over $1 million.

    In 2009, clinicians at a Syracuse hospital declared Colleen Burns dead following a drug overdose. Despite several signs of responsiveness to stimuli, the hospital continued to prepare her for organ procurement. Then, just as surgery was about to commence, Burns opened her eyes in the operating room. The surgery was immediately canceled and Burns was released 2 weeks later. In 2013, the New York Department of Health fined the hospital $6,000 for improperly implementing brain death protocols. In addition, the Centers for Medicare and Medicaid Services (CMS) sanctioned the hospital for failing to undertake an "intensive and critical review of the event."…

    On January 24, 2014, almost 2 months after suffering her fatal event, State District Judge R.H. Wallace held that the statute concerning "life-sustaining treatment" did not apply to a patient who was dead. The judge ordered the hospital to terminate Muñoz's cardiopulmonary support


  19. The National Post’s Tom Blackwell, noting that details of the case are “sketchy”, recounted the known facts: a British Columbia hospital kept a brain-dead patient alive for ten days in ICU as his family prepared to fly him to the country of his birth. The family said they did not believe the man was dead. The province, in turn, did not register his death...

    The issue is the definition of clinical death and who is charged with making the call. The medical community used to regard death as occurring when the heart stops beating in a regular rhythm. But today, since organs can be made to function through the intervention of life support devices, clinical death is now regarded as a stage before “final death”.

    UBC professor Dr. Peter Dodek says the grey area swings open a door that no one has been able to close.

    “When the family does not accept the diagnosis of brain death, we’re in a dilemma,” said Dodek. “And the dilemma is essentially our values versus the family’s.”...

    While McNath’s family presented evidence that suggested brain activity in Jahi, presenting videos that purport to show the girl moving her limbs at her mother’s request, six medical professionals who performed tests on her said she showed signs no signs of brain function.

    Rebecca Dresser, a professor of law and ethics in medicine at Washington University School of Law in St. Louis said an ongoing examination of the facts in the case could find evidence that support their collective conclusion.

    “Or,” she said. “It shows that medical authorities don’t know everything about brain death, that there may be cases that seem to fit the medical criteria where people are actually not brain-dead.”


  20. A 12-year-old boy declared brain dead by doctors after a boating accident died on Monday while still on life support.

    Jonah Panduro had been in a medically induced coma for a week. He was inner tubing on Lake Kaweah last Sunday when a metal loop snapped off the tube and became lodged in his head.

    The boy's family had been fighting to keep him on life support, even though the doctors had pronounced him brain dead.

    According to members of the family, Jonah was still on life support when he passed away.


    "Jonah is in a better place now and we tried and we tried", says Magali Panduro, Jonah's aunt.

    Moments after Jonah Panduro's death, his aunt spoke with us about their Journey. She says that Jonah was still reacting to his fathers voice, but that three days ago, doctors at CRMC declared him brain dead...

    Family members tell us that they wanted to keep Jonah on life support, despite the grim prognosis of doctors. We spoke with several lawyers about what rights to parents have, whether or not they can keep their children on life support, if the doctors suggest to take them off.

    "Clearly they are going to have more than one expert look over their EEG's to determine if there is any activity and if there is no activity, there is nothing they can do to keep him alive", says legal analyst, attorney Charles Magill.

    A year ago, attorney Chris Dolan represented Jahi McMath's case. she was undergoing a routine surgery, when complications put her on life support. Doctors suggested she be allowed to die, but when the family hired Dolan, they were able to transfer Jahi to a long term care facility in New Jersey where she is still alive today.

    "Each of the cases, Jahi's case and this arise out of a horrible tragedy and the common factor as to who gets to make the decision of whether or not the child is alive or dead", says Dolan.

  21. An apnea test did nothing to help Aden. Fanuel, father and Guardian of Aden, directed not to do an apnea test. Nevertheless, it was done. This caused carbon dioxide and acids in Aden to go very high. This test was not good for Aden. When the doctors did not observe Aden taking in a breath, the doctors declared that Aden was "brain dead." Once that declaration of "brain death" was made, which in most states is considered a legal definition of death, the family was told that treatment and care would be discontinued. Aden's father needed to go to court to fight for necessary treatment and care for his daughter...

    Aden's family is extremely grateful to the Nevada doctors who came forward to treat Aden. At least the entire medical community did not turn their back to Aden. The doctors treating Aden have declared that Aden is "brain dead." Their testimony in court convinced the judge that criteria for "brain death" were fulfilled. The judge determined that my recommendation for thyroid hormone was insufficiently supported and theoretical. Aden has very low amounts of thyroid hormone. The brain (hypothalamus) makes Thyroid Stimulating Hormone" (TSH). TSH has a very short half-life and has been measured in the circulation of Aden. This test demonstrated that Aden's hypothalamus is alive and receiving enough circulation to remain alive to produce TSH. In addition, body temperature is also maintained by hypothalamus. Therefore, if body temperature is maintained without heating blankets, the hypothalamus is alive. If the hypothalamus is alive and receiving enough blood supply to remain alive and working to produce TSH and maintain body temperature, although no signs of intracranial circulation can be detected by any current test for circulation to the brain, then other parts of the brain may also be alive and receiving enough blood supply to remain alive (despite no signs of intracranial circulation being detected by any current confirmatory test for "brain death"). Those other parts of the brain may be only functionally silent but not irreversibly damaged. But, they may need higher levels of thyroid hormones to heal and have a chance to resume activity. The whole brain needs thyroid hormones to resolve swelling, resume normal intracranial pressure and thereby resume normal circulation and function. Why will the doctors not treat a documented, treatable condition and give Aden the best possible chance to continue to live and hopefully recover?...

    The judge determined that continued treatment of Aden was not in Aden's "best interests" and life support is to be removed in 10 days. How can it be in the best interest of Aden, a 20 year old college student, to have her life snuffed out by removing her life support without giving her thyroid hormone, adequate support of respiration and full nutrition?

  22. If you need a heart transplant in the UK, you’re likely to be waiting a while – on average six months. With something as serious as a heart transplant, that wait will be too long for some, with some estimates suggesting that around 15% of patients will die waiting for a replacement ticker to come available.

    The main reason for this is that donor hearts can only be taken from living subjects – patients who have suffered brain-death have their organs removed while they’re still functioning, allowing for a safe transplant. In short, there aren’t that many donors that meet these requirements, so waiting lists for heart transplants tend to be long and stressful.

    That may change, thanks to a brand-new invention developed by TransMedics, a device that has already been used successfully in 15 transplants in the UK and Australia. Put simply, it allows dead hearts to be “reanimated” and used again to save someone else’s life: the “heart-in-a-box”.

    Unlike current transplants, where the organ is chilled to around 4°C to reduce the metabolic activity, the device keeps the heart warm. It’s then transferred to a sterile chamber on a wheeled cart, where tubing is clamped onto the heart giving it a steady supply of blood, oxygen and nutrients...

    There are three things blocking the heart-in-a-box from transforming heart transplants as we know them: practical, financial and ethical.

    The practical one isn’t too much of a bar: the heart needs to be from someone recently deceased – you can’t reanimate long-dead hearts, as you might imagine. Still, this does mean the heart-in-a-box needs to be in the right place at the right time, which leads us to problem number two: financial.

    The heart-in-a-box costs $250,000 (around £160,000), making it an expensive piece of technology for every hospital to have ready to deploy at any given moment.

    The ethical one is where things get really interesting. Previously, if someone’s heart stopped and they died, they would be officially dead. But how can they be, if we can remove the heart, reanimate it and give it to someone else? Or as medical ethicist Dr Robert Truog said to Technology Review, “How can you say it’s irreversible, when the circulatory function is restored in a different body? We tend to overlook that because we want to transplant these organs.”

    “My argument is that they are not dead, but also that it doesn’t matter. They are dying and it’s permissible to use their organs. The question is whether they are being harmed, and I would say they are not,” he added.