CURRENT CONCEPTS OF DEATH: BRAIN DEATH AND CIRCULATORY DEATH “ A CONTINUOUS DISCUSSION ABOUT THE DIAGNOSIS CRITERIA AND TH...
<ul><li>I).- CURRENT CRITERIA FOR BRAIN DEATH DIAGNOSIS AND ADDITIONAL RECOMMENDATIONS </li></ul><ul><li>II).- DEFINITION ...
<ul><li>UPDATE </li></ul><ul><li>Wijdicks E; Varelas P, Gronseth G, Greer D. “Evidence-based guideline update: Determining...
<ul><li>Some differences in criteria to confirm brain death between the countries which conform the RCIDT, those aren’t es...
<ul><li>Consider  ORGAN DONATION </li></ul><ul><li>If there  is no donor: wean off the  body and deliver it to the family ...
DEFINITON OF DEATH AND CONSCIOUSNESS <ul><li>Definition of death based on the basic mechanism of consciousness generation ...
DEFINITON OF DEATH AND CONSCIOUSNESS <ul><li>Meets only ABSENCE OF BRAIN RESPONSES </li></ul><ul><li>Unmet ABSENCE BRAIN S...
DEFINITON OF DEATH AND CONSCIOUSNESS <ul><li>For the legal framework  of each country the biological criteria to certify B...
DEFINITON OF DEATH AND CONSCIOUSNESS <ul><li>PVS and MCS </li></ul><ul><li>These facts  don’t have and should not have a r...
CURRENT CHALLENGES IN DEATH DIAGNOSIS <ul><li>ORGAN DONATION AND DEATH </li></ul><ul><li>Need to improve Cardiac DEATH Don...
CURRENT CHALLENGES IN DEATH DIAGNOSIS: <ul><li>President’s Commission for Uniform Declaration of Death Act   (UDDA): 2 cri...
CURRENT CHALLENGES IN DEATH DIAGNOSIS: <ul><li>Harvard Report (1968):  </li></ul><ul><li>“ Obsolete criteria for  </li></u...
CURRENT CHALLENGES IN DEATH DIAGNOSIS: <ul><li>¿How much time should elapse for CPA to meet BD?? </li></ul><ul><li>Is it n...
CURRENT CHALLENGES IN DEATH DIAGNOSIS: <ul><li>What has to be specified and agreed upon is the medical behavior after deat...
Conclusions <ul><li>These fascinating debates concerning definition of death should be and must be within philosophical, e...
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Maria Elisa Barone - Argentina - Tuesday 29 - Death Diagnosis and Organ Procurement Current concepts of

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Maria Elisa Barone - Argentina - Tuesday 29 - Death Diagnosis and Organ Procurement Current concepts of

  1. 1. CURRENT CONCEPTS OF DEATH: BRAIN DEATH AND CIRCULATORY DEATH “ A CONTINUOUS DISCUSSION ABOUT THE DIAGNOSIS CRITERIA AND THE MEANING OF THIS DIAGNOSIS” Dra. María Elisa Barone
  2. 2. <ul><li>I).- CURRENT CRITERIA FOR BRAIN DEATH DIAGNOSIS AND ADDITIONAL RECOMMENDATIONS </li></ul><ul><li>II).- DEFINITION OF DEATH AND CONSCIOUSNESS </li></ul><ul><li>III).- CURRENT CHALLENGES IN DEATH DIAGNOSIS </li></ul>A CONTINUOUS DISCUSSION ABOUT THE DIAGNOSIS CRITERIA AND THE MEANING OF THIS DIAGNOSIS
  3. 3. <ul><li>UPDATE </li></ul><ul><li>Wijdicks E; Varelas P, Gronseth G, Greer D. “Evidence-based guideline update: Determining brain death in adults. Report of the Quality Standards Subcommittee of the American Academy of Neurology” Neurology 2010 ; 74; 1911-1918 </li></ul><ul><li>Guidelines for the Determination of Brain Death in Infants and Children: An Update of the 1987 Task Force Recommendations. The Society of Critical Care Medicine, Section on Critical Care and Section on Neurology of the American Academy of Pediatrics, and the Child Neurology Society. Pediatrics 2011 ; 128; e720; originally published online August 28, 2011; DOI: 10.152/peds.2011 – 1511 </li></ul><ul><li>Protocolo Nacional para Certificar el Diagnóstico de Muerte. Ministerio de Salud de la Nación. Argentina. Resolución nº 275/2010. Boletín Oficial nº 31.844 16 febrero 2010 </li></ul>CURRENT CRITERIA FOR BRAIN DEATH DIAGNOSIS AND ADDITIONAL RECOMMENDATIONS
  4. 4. <ul><li>Some differences in criteria to confirm brain death between the countries which conform the RCIDT, those aren’t essential. </li></ul><ul><li>Most countries agree whit the clinical requirement to certify </li></ul><ul><li>ABSENCE OF CEREBRAL RESPONSES </li></ul><ul><li>ABSENCE OF BRAIN STEM REFLEXES </li></ul><ul><li>APNEA </li></ul><ul><li>Difference is whether or not to have the requirement for ancillary tests </li></ul>CURRENT CRITERIA FOR BRAIN DEATH DIAGNOSIS AND ADDITIONAL RECOMMENDATIONS
  5. 5. <ul><li>Consider ORGAN DONATION </li></ul><ul><li>If there is no donor: wean off the body and deliver it to the family </li></ul><ul><li>RCIDT Informe/Recomendación REC-RCIDT-2008 (9) “Sobre la Muerte Encefálica en Iberoamérica” Newsletter Vol.II- Nº1. Octubre 2008. </li></ul><ul><li>Escudero D, Matesanz R, Soratti C, Flores J I en nombre de la RCIDT. “ Muerte Encefálica en Iberoamérica” . Med. Intensiva . 2009 ; 33 (9): 415-423 </li></ul>CURRENT CRITERIA FOR BRAIN DEATH DIAGNOSIS AND ADDITIONAL RECOMMENDATIONS
  6. 6. DEFINITON OF DEATH AND CONSCIOUSNESS <ul><li>Definition of death based on the basic mechanism of consciousness generation in human beings </li></ul><ul><li>Death is absence of Arousal and Awareness </li></ul><ul><li>Machado, Calixto “A new definition of death based on the basic mechanisms of consciousness generation in human beings” Developments in Neurology 9 Brain Death. Amsterdam, Holland. Ed.Elsevier 1995. pp. 57-66. </li></ul>
  7. 7. DEFINITON OF DEATH AND CONSCIOUSNESS <ul><li>Meets only ABSENCE OF BRAIN RESPONSES </li></ul><ul><li>Unmet ABSENCE BRAIN STEM RESPONSES AND APNEA </li></ul><ul><li>This criterion meets only one of the clinical requirements </li></ul>
  8. 8. DEFINITON OF DEATH AND CONSCIOUSNESS <ul><li>For the legal framework of each country the biological criteria to certify Brain Death should not be limited to just the consciousness function </li></ul>
  9. 9. DEFINITON OF DEATH AND CONSCIOUSNESS <ul><li>PVS and MCS </li></ul><ul><li>These facts don’t have and should not have a relationship with ORGAN DONATION . </li></ul><ul><li>They should be neurological, neurophysiological and ethical issues regarding other medical behaviors </li></ul>
  10. 10. CURRENT CHALLENGES IN DEATH DIAGNOSIS <ul><li>ORGAN DONATION AND DEATH </li></ul><ul><li>Need to improve Cardiac DEATH Donation (DCD) not only Brain Death Donation (BDD) </li></ul>
  11. 11. CURRENT CHALLENGES IN DEATH DIAGNOSIS: <ul><li>President’s Commission for Uniform Declaration of Death Act (UDDA): 2 criteria </li></ul><ul><li>It was reconfirmed that BD diagnosis is the death of the human beings. </li></ul><ul><li>Cardiopulmonary criteria imply death because who meets CPC meets BDC too. </li></ul>
  12. 12. CURRENT CHALLENGES IN DEATH DIAGNOSIS: <ul><li>Harvard Report (1968): </li></ul><ul><li>“ Obsolete criteria for </li></ul><ul><li>the definition of death </li></ul><ul><li>can lead to controversy </li></ul><ul><li>in obtaining organs for </li></ul><ul><li>transplantation” </li></ul>
  13. 13. CURRENT CHALLENGES IN DEATH DIAGNOSIS: <ul><li>¿How much time should elapse for CPA to meet BD?? </li></ul><ul><li>Is it necessary??? </li></ul><ul><li>This should not be a problem </li></ul><ul><li>The protocols for death confirmation should respond to patient’s clinical evolution and to disease outcome. </li></ul><ul><li>This means that the death criterion should be in accordance with medical and biological bases. </li></ul>
  14. 14. CURRENT CHALLENGES IN DEATH DIAGNOSIS: <ul><li>What has to be specified and agreed upon is the medical behavior after death certification and not the clinical criteria to certify DEATH </li></ul><ul><li>One issue is to establish the criteria to certify death </li></ul><ul><li>Another very different issue is to agree on the intervention behavior after death certification </li></ul>
  15. 15. Conclusions <ul><li>These fascinating debates concerning definition of death should be and must be within philosophical, ethical, anthropological and cultural debates. </li></ul><ul><li>For medical and legal framework goals, the criteria to certify death should always be based on biological consensus and technological advances and not on organ donation </li></ul>
  16. 16. Thanks for your attention!

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