DÄ internationalArchive6/2019Is Irreversible Loss of Brain Function a Reliable Sign of Death?

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Is Irreversible Loss of Brain Function a Reliable Sign of Death?

Dtsch Arztebl Int 2019; 116: 98. DOI: 10.3238/arztebl.2019.0098a

Parzeller, M; Zedler, B; Verhoff, M A

LNSLNS

Describing irreversible loss of brain function (ILBF) as “the biological end of the life of a human being” (1) does not tally with the thanatological definition of biological death as the death of the last cell (2). The two are not equivalent. The review article itself makes this clear with its description of the function of the pituitary gland.

One collaborator listed in Box 3 in the article (1) doubts the admissibility of equating death with ILBF (3). The cited position of the German Ethics Council (4) is equivocal in this context, but this was not mentioned in the article.

From a scientific-medical perspective, several definitions of death exist (for example, clinical death; ILBF as individual death but, by contrast, ILBF as an “extreme minimal living state”[4]; biological death). Even the legislator differentiates in § 3 I 1 No 2 of the German Transplant Act (TPG) between death as an admissibility criterion and, in § 3 II No 2 TPG, brain death (=final, irreversible loss of all function of the cerebrum, cerebellum, and brainstem) as an inadmissibility criterion, and names in § 5 I 2 TPG the final irreversible cardiac arrest.

In spite of the explanation and the erroneous description of the fourth revision of the German Medical Association’s guideline, no complete and acceptable rules for establishing death according to §§ 3 I 1 No 2, 16 I 1 No 1 TPG exist. This is obvious—among other reasons—from the fact that the guideline is lacking information on putrefaction as a reliable sign of death, as well as well-founded guidance on establishing death (apart from ILBF).

For whom or what the German Medical Association as a non-registered association deserved a special role in the sense of a guarantor function (1) was not explained.

DOI: 10.3238/arztebl.2019.0098a

Assessor Prof. Dr. med. Dr. med. habil. Markus Parzeller

Institut für Rechtsmedizin, Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt am Main

parzeller@em.uni-frankfurt.de

Prof. Dr. med. Marcel A. Verhoff

Institut für Rechtsmedizin, Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt am Main

Dr. med. Barbara Zedler

Institut für Rechtsmedizin der Universitätskliniken Gießen und Marburg

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.
Bajanowski T, Brinkmann B: Todesbegriffe und Todesfeststellung. In: Brinkmann B, Madea B (eds.): Handbuch gerichtliche Medizin 2004; p. 13–18.
3.
Birnbacher D: Der Hirntod – der Tod? DZPhil 2012; 60: 422–3.
4.
Deutscher Ethikrat (eds.): Hirntod und Entscheidungen zur Organspende. Stellungnahme. www.ethikrat.org/fileadmin/Publikationen/Stellungnahmen/deutsch/stellungnahme-hirntod-und-entscheidung-zur-
organspende.pdf (last accessed on 17 October 2018): p. 102; p.159.
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. Bajanowski T, Brinkmann B: Todesbegriffe und Todesfeststellung. In: Brinkmann B, Madea B (eds.): Handbuch gerichtliche Medizin 2004; p. 13–18.
3. Birnbacher D: Der Hirntod – der Tod? DZPhil 2012; 60: 422–3.
4.Deutscher Ethikrat (eds.): Hirntod und Entscheidungen zur Organspende. Stellungnahme. www.ethikrat.org/fileadmin/Publikationen/Stellungnahmen/deutsch/stellungnahme-hirntod-und-entscheidung-zur-
organspende.pdf (last accessed on 17 October 2018): p. 102; p.159.

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