Pertinent Points Need to Be More Convincingly Stated
The excellent, clear, and persuasive explanation of the importance of brain death will serve as a great orientation aid to colleagues (1). Two points, however, could have been stated more convincingly:
- The insistence that even in primary infratentorial lesions the loss of cerebral function should always be documented is justified in the article as being “in the interest of internal consistency.” In these patients with primary loss of brainstem function and sustained function of the large hemispheres, as well as possibly reproducible visually evoked potentials, the current state of science does not allow for ascertaining the degree to which perception—that is, consciousness—is still a possibility. A more precise way of reasoning would be: In primary infratentorial lesions the irreversible loss of supratentorial brain function must be confirmed, because all brain functions are to be excluded—including any consciousness.
- In terms of the popular but incorrect notion that brain death was defined in order to enable organ explantation, the authors rightly say that the German Society for Surgery published brain death criteria before the Harvard Ad Hoc Committee in 1968. This argument is likely to convince but few because the public debate about how to define the death of an organ donor received the attention of the public earlier than that, in December 1967, after the first heart transplantation. The authors of the first scientific accounts, neurosurgeons Wertheimer in 1959 and Tönnis and Frohwein in Germany in 1963 (2) regarded brain death merely as a justification to stop treatment (3). The option of organ donation was not known and was therefore not discussed. The diagnosis of brain death was used for organ donations only after these scientific contributions. The German Society for Surgery and the Harvard Ad Hoc Committee based their recommendations on these scientific findings.
Prof. Dr. med. Raimund Firsching
Direktor der Universitätsklinik für Neurochirurgie
|1.||Brandt SA, Angstwurm H: The relevance of irreversible loss of brain function as a reliable sign of death. Dtsch Arztebl Int 2018; 115: 675–81 VOLLTEXT|
|2.||Tönnies W, Frowein RA: Wie lange ist Wiederbelebung bei schweren Hirnverletzungen möglich? Mschr Unfallheilkunde1963; 66: 169–90.|
|3.||Frowein RA, Firsching R: Hirntod-Diagnose in Deutschland. In: Deutsche Gesellschaft für Neurochirurgie (eds.): Neurochirurgie in Deutschland: Geschichte und Gegenwart. 50 Jahre Deutsche Gesellschaft für Neurochirurgie. Berlin, Wien: Blackwell Wissenschafts-Verlag 2001; 203–18.|