Friday, August 21, 2015

"Post-mortem" movements

The head of the non-profit group coordinating organ donation for most of New Jersey hopes the story of Mikey Lavecchia doesn't taint the public's view of organ donation.

"I hope the public understands that this is not an issue that was created by the need to have an organ donation," Joe Roth, president and CEO of NJ Sharing Network, said.

Michael "Mikey" Lavecchia, 13, was pronounced dead Sunday by doctors at St. Joseph's Medical Center in Paterson. He was in a car that crashed into a truck Saturday on the side of Route 80 eastbound in Wayne, killing the other two occupants, including his father, Michael Jr.
Laureen Lavecchia chose to donate Mikey's organs. As she kept a vigil over him Sunday night while waiting for a recipient, she saw him move his legs, shoulders and arms.

A review of scientific literature on movements after brain death, published in March 2009 in the Canadian Journal of Neurological Sciences, found movements were present in as many as half of heart-beating cadavers, though it's not clear why. The authors concluded such movements "do not invalidate" a brain death diagnosis.

Laureen has since moved Mikey, who recently moved with his father from Brentwood, N.Y., to East Stroudsburg, Pa., to Robert Wood Johnson University Hospital in New Brunswick. She said Thursday there had been no change in Mikey's condition...

"The staff at our children's hospital is vastly experienced in providing clinical care in this area and remains committed to providing any assistance to the Lavecchia family in seeking answers to any unanswered questions. Our desire is to be supportive of the family as they continue to deal with this tragedy."

Laureen has said she has not ruled out donating Mikey's organs, but is focused on his recovery.
Roth, who said NJ Sharing Network has helped coordinate more than 400 transplants, said the Lavecchias' situation is a first.

"We've not had situations like this in my experience," he said.

NJ Sharing Network doesn't become involved with patients until they're pronounced dead, Roth said. Families sometimes back out after that point, but usually because not every family member agrees with the decision to donate.

The need for organ transplants is huge, Roth said.

"Right now, just New Jersey patients, there are over 5,000 people waiting for transplants," he said...

"My heart goes out to her," Kuzminksi said of Laureen Lavecchia. "I pray there is a better outcome than what it looks like there's going to be. I hope that her decision to donate his organs will still be the same decision. To have something come positive come out of a tragedy was a very healing experience for our family."


  1. Saposnik G, Basile VS, Young GB. Movements in brain death: a systematic
    review. Can J Neurol Sci. 2009 Mar;36(2):154-60.

    Brain death is the irreversible lost of function of the brain including the brainstem. The presence of spontaneous or reflex movements constitutes a challenge for the neurological determination of death. We reviewed historical aspects and practical implications of the presence of spontaneous or reflex movements in individuals with brain death and postulated pathophysiological mechanisms. We identified and reviewed 131 articles on movements in individuals with confirmed diagnosis of brain death using Medline from January 1960 until December 2007, using 'brain death' or 'cerebral death' and 'movements' or 'spinal reflex' as search terms. There was no previous systematic review of the literature on this topic. Plantar withdrawal responses, muscle stretch reflexes, abdominal contractions, Lazarus's sign, respiratory-like movements, among others were described. For the most part, these movements have been considered to be spinal reflexes. These movements are present in as many as 40-50% of heart-beating cadavers. Although limited information is available on the determinants and pathophysiological mechanisms of spinal reflexes, clinicians and health care providers should be aware of them and that they do not preclude the diagnosis of brain death or organ transplantation.

  2. Michael "Mikey" Lavecchia III was pronounced brain dead at 11:55 a.m. Sunday at St. Joseph's Regional Medical Center.

    He had been riding from East Stroudsburg, Pennsylvania with his father, Michael Jr., and Giovanni Laboy, the 14-year-old brother of Michael Jr.'s fiancee, when their car slammed into the back of a Mack truck parked on the side of Route 80 eastbound. Michael Jr. and Giovanni died Saturday.

    After Mikey was pronounced dead, his mother, Laureen Lavecchia, chose to donate his organs. Doctors kept the boy on life support while they sought a recipient.

    While Laureen kept vigil over Mikey Sunday night, she saw him jerk his shoulders. He later moved his arms and legs, she said.

    "The doctor that saw him jerking his shoulders said he had never seen that happen," she said.

    Laureen had Mikey removed from the donor list, and the death pronouncement reversed.

    "He's officially not dead," she said.

    On Tuesday, Mikey underwent a second series of tests for brain activity. He failed to respond.

    Laureen said she wouldn't give up and believes her son will eventually heal.

    "We need to try more," she said...

    "I have my hope restored," Laureen said. "Right now I'm just fighting for his life."

  3. Mikey's mother, Laureen Lavecchia, kept a vigil over Mikey Sunday night while doctors looked for someone to receive his organs, Lavecchia Sr. said. That's when she first saw him move, he said.

    Hernandez and Levacchia Sr. had the death certificate destroyed Monday night after seeing Mikey move, Lavecchia Sr. said.

    Lavecchia Sr. said a neurologist had never seen his grandson at St. Joseph's. They were waiting Tuesday for a neurologist to assess him.

    "All they were interested in, in my opinion, was using his organs," he said. "If his mother didn't stay there all night they would have taken him off life support."

    A spokeswoman for St. Joseph's declined to comment, citing patient privacy laws.

  4. While opting not to name any of the hospital or organ transplant officials at the crux of the family’s complaints, LaVecchia said St Joseph’s did not evaluate the boy thoroughly enough and was too aggressive in trying to persuade the family to agree to the organ donations.

    “I feel that one day’s worth of testing is not nearly enough, or one day’s worth of waiting to see if anything’s possible is not nearly enough,” she said. “I do believe that they were after my son’s organs and I wanted him out of there.”

    Medical experts with no connection to the case said it’s not uncommon for patients declared brain dead to continue to have involuntary movements. And those movements can cause much confusion and anguish for a family still reeling from the shock of a devastating accident, said Arthur Caplan, director of the NYU School of Medicine’s Division of Medical Ethics.

    Steven Lomazow, a Belleville neurologist and former member of the state Board of Medical Examiners, said that changing blood chemistry can be the cause of such movements. An electrolyte imbalance, he said, “would cause the body to go into certain types of movements and spasms.”

    In the interview, Michael’s mother mentioned two tests that were performed — an apnea test and a brain blood-flow test. In an apnea test, the patient is taken off a ventilator for 10 minutes to see if he begins breathing on his own, and the carbon dioxide level of the blood is measured. A blood-flow test determines if blood is flowing to the brain.

    “While the brain flow tests showed that he had no flow and they were claiming him to be brain dead, there was things that the doctor was not able to explain and in speaking to other physicians, other neurologists, other people that have experienced this, other advocates in this field, people have been known to come back from the same situation my son is in,” his mother said.

    But Lomazow, who is also president of the New Jersey Neurological Association, said, “there’s never been a case in the history of man, where a well-conducted blood-flow study showed no flow and anybody ever regained function.”

  5. A 13-year-old boy deemed brain dead until his family saw him move was transferred Tuesday night to Robert Wood Johnson University Hospital in New Brunswick, his mother told NJ Advance Media.

    Neurologists plan to examine Michael "Mikey" Lavecchia III for brain function, his mother Laureen Lavecchia said...

    His family had doctors reverse the death pronouncement after seeing Mikey move his shoulders, arms and legs. Laureen, of Lindenhurst, N.Y., had sought to transfer Mikey to Stony Brook University Medical Center on Long Island, but the move was deemed "not medically appropriate."

    Laureen explored other options, and had heard good things about Robert Wood. Mikey is currently at the Bristol-Myers Squibb Children's Hospital at Robert Wood.

    Mikey's condition hasn't changed, Laureen said. On Tuesday at St. Joseph's he failed to respond to a second series of tests for brain activity. He's still making small movements, she said.

    Laureen first saw Mikey move while he was on life support as doctors looked for a recipient for his organs. She has not ruled out donating if her son's condition fails to improve.

    "I'm just taking it one day at a time," she said. "Just waiting to see what the surgeons and neurologists have to say."

  6. Nearly three weeks after doctors at one medical center declared him brain dead and his family moved him to another hospital, a 13-year-old boy is still showing signs of life, his mother said, and friends and family are raising money to fly in an international specialist to examine him...

    As she waits for more definitive findings, Laureen LaVecchia said she is seeking input from clinicians who have differing — and sometimes controversial — views on how much time and testing is needed before a diagnosis of “brain death” can be made...

    Bracing for what may be an even longer and more grueling vigil, LaVecchia said she has begun researching facilities where Mikey, as she and others often refer to him, could be cared for on a ventilator and feeding tube...

    LaVecchia said she has been in contact with the International Brain Research Foundation, a Flanders-based organization that has received criticism from some medical quarters for conducting expensive experimental treatments on people in persistent vegetative states or prolonged comas.

    Philip DeFina, the clinical psychologist who serves as the chief scientific officer of the foundation, has argued in general that more sophisticated testing of brain trauma victims is needed before doctors declare that any damage is irreversible. He has not commented on the LaVecchia case. But both his credentials and his theories are the subjects of much dispute, with critics saying his foundation’s treatments raise families’ hopes in cases where prognoses are poor...

    LaVecchia said she wants to investigate all possible options, and that many doctors she has consulted tell her that the brain remains a mystery compared with what is known about other parts of the body.

    “We’re just focusing on what the next step should be, and the next step is to get this specialist here to see him,” she said in the interview Thursday...

    There are some additional, more specialized scans that LaVecchia hopes can be conducted on her son, but doctors have held off on exposing him to the additional radiation at this time, she said. In the meantime, she said, Mikey continues to make movements and appeared to respond to pain when touched in an injured area. He also has been receiving nutrients and hormone therapies, she said.

    “They are very understanding and supportive of my reaching out to outside sources,” she said of Robert Wood Johnson. “This hospital is an amazing hospital.”

    While his hospital care, for the time being, remains covered by insurance, family and friends are trying to raise money to pay for outside consultations, LaVecchia said. A GoFundMe account named Team-Mikey features pictures of him with the slogans, “Signs of Life” and “Pray for Mikey.” As of Thursday, the fund had raised more than $4,000 of the $6,500 LaVecchia said is needed to make the specialist’s visit happen.

  7. It may seem unlikely but there is a chance a 13-year-old California girl declared brain dead after suffering complications following a routine tonsillectomy could recover.

    At least, that's what doctors with a New York-based neurological foundation believe.

    Dr. Jonathan Fellus, the chief medical officer with the International Brain Research Foundation, a nonprofit group that specializes in treating coma patients and claims to have helped hundreds of people deemed brain dead awaken from comas, is in California to assist Jahi McMath's family...

    Fellus' goal is to help determine if the young girl can achieve some kind of recovery.

    Although he has yet to examine her personally at Children's Hospital in Oakland, he is expected to be there Tuesday and said he has already looked over her records.

    "We need to examine her further," IBRF Chief Executive Officer Dr. Philip Defina told the Daily News on Tuesday. "There is hope."

    What Jahi needs, he noted, was more time. "Why wouldn't you want to examine it further?" he said. "Why do we want to jump ahead and pull the plug on this 13-year-old girl who may have a chance to recover?"

    Fellus told The News she needs to spend more time in the hospital to recover from her cardiac arrest and to determine if she could wake from the coma. He said her young age and that she suffered the cardiac arrest in a hospital and was quickly treated are both positive factors that favor possible recovery.

    "Basically we need the dust to settle," he said. "It's difficult to see a clear picture [in a patient's brain after a cardiac arrest]. It's still not a clear picture."

    These doctors, who are handling the case pro-bono, are also challenging the status-quo definition of brain dead in the medical field and what it really means for the patient.

    “Most radically spectacular things were (once) considered impossible," Fellus said. "That means you have to start somewhere.”

    Defina said that the legal definition of brain dead was coined in the 1960s and that there is a debate in the neurological community as to whether someone who meets these possibly outdated criteria — based on the technology of the day — can still recover.

    "There are a lot of empirical problems with technology as archaic as that," he said.

    Defina admits his theories are not universally accepted and that there is skepticism about his ideas in the medical community. Some of his methods, which include additional testing and consultations with experts, are also not covered under many insurance plans.

    Fellus has said that when a patient is declared brain dead "the machine is unstoppable" and they almost always are taken off life support. But there are examples of cases in which the patient can still recover.

    There have also been cases in which a patient has signs of brain activity, but it's suppressed because the individual was given a high levels of drugs, Defina said.

    That said, Defina can’t speculate further about Jahi’s possible recovery, saying at this point it would just be "guess work."

    "No one can make that determination today," he said. "You want to err on the side of caution and not take away a life. You want to give her a few weeks and see if she responds."

    So far, Jahi has shown some signs of responding. Specifically, Defina said he's been told by the family's attorney Chris Dolan that she has made movements when her parents speak to her.

    Defina rejects any claims these movements are an involuntary muscle reflex, claiming the movements are only done when she hears her parents' voice.

    - See more at:

  8. A 13-year-old boy who suffered devastating head injuries in a car accident died on Thursday, his mother said, ending his family’s monthlong quest for more testing and medical opinions about whether he had truly suffered a “brain death.”

    Michael “Mikey” LaVecchia died at Robert Wood Johnson University Hospital in New Brunswick, where he was transferred three days after the Aug. 15 accident on Route 80 in Wayne that killed his father and another boy.

    Mikey was originally brought to St. Joseph’s Regional Medical Center in Paterson, where — 24 hours after the accident — doctors had declared him to be brain dead.

    His mother, Laureen LaVecchia, initially consented to donate his organs, but then clashed with doctors there after becoming dissatisfied with the explanations they gave for a series of movements family members saw the boy make, including lifting his arms, head and shoulders off the bed.

    LaVecchia, a Long Island resident, grew concerned that the diagnosis had been rushed. “One day’s worth of waiting to see if anything’s possible is not nearly enough,” she said.

    Experts say such involuntary movements can occur after someone is determined to be brain dead, causing families much confusion and anguish, and are usually attributable to spinal reflexes or chemical changes in the body.

    Since his transfer to Robert Wood Johnson, Mikey underwent a magnetic resonance imaging, or MRI, test and his mother sought advice from outside-the-mainstream groups such as the International Brain Research Foundation, which advocates for the use of more sophisticated image testing of the brain.