DÄ internationalArchive6/2019Metaphysical and Cultural Aspects
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The review article (1) explicitly excludes metaphysical and cultural questions. For this reason it is not capable of producing a consensus—neither as a profound explanation for potential organ donors nor as the basis of a universally binding law, not even within the medical profession. The authors overlooked all human beings for whom consciousness (to use the words of Max Planck) is fundamental. From this perspective, “brain dead” people are terminal patients in whom life-prolonging measures are not indicated, but who are still neither dead nor without sensation, but dying, suffering, and defenseless, not able to communicate their inner lives because the tool for this—the brain—is missing.

From a medical perspective the article is not immune to challenge:

  • A complete loss of function of the cerebrum, cerebellum, and brainstem cannot be confirmed by applying the currently used diagnostic methods (2). The criteria of brain death do not rule out that parts of the brain perceive external stimuli and can react to such stimuli (3).
  • The fact that the organs of the organism have their own coordinating function independently of the brain is not something that can be disproved in one sentence. Also, a great difference exists between total loss of function and isolation of one organ.
  • Historically it can be clearly documented that the Harvard Committee with its definition of brain death primarily considered the needs of transplantation medicine (4).

Experts in the German Medical Association have attempted for many years to ignore the international consensus on brain death (brain dead patients are dying patients but are still alive) and maintain their own concept. How much longer is this going to work?

DOI: 10.3238/arztebl.2019.0097b

Dr. med. Hans-Joachim Ritz

Hannover, hajoritz@arcor.de

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.
Rehder S: Grauzone Hirntod – Organspende verantworten. Augsburg: Sankt Ulrich Verlag GmbH 2010; p. 58.
3.
Owen A: Zwischenwelten – Ein Wissenschaftler erforscht die Grauzone zwischen Leben und Tod. München: Droemer 2017.
4.
Henderson DS: Death and donation—Rethinking brain death as a means for procuring transplantable Eugene, Oregon (USA): Pickwick Publications 2011; p. 6–10.
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.Rehder S: Grauzone Hirntod – Organspende verantworten. Augsburg: Sankt Ulrich Verlag GmbH 2010; p. 58.
3.Owen A: Zwischenwelten – Ein Wissenschaftler erforscht die Grauzone zwischen Leben und Tod. München: Droemer 2017.
4.Henderson DS: Death and donation—Rethinking brain death as a means for procuring transplantable Eugene, Oregon (USA): Pickwick Publications 2011; p. 6–10.

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