Brain death and human death

The conceptual life is the result of many organs and organs in the body to maintain and develop each individual. Or in other words living is against death.

In the legal aspect, the majority of countries in the world recognize the status of the people of their own country starting when the baby was born and ended with the death of that person. Medicine considers people who commit suicide and intend to commit suicide who have a mental disorder even for a moment.

When are people considered dead?

Everyone has the right to life, which is absolutely protected by the constitution of each country, except in some special cases such as the mother having to give up her fetus for her own health.

It is very important to define and correctly diagnose human death. In order not to commit murder, even if it is unintentional, the burial of the dead and the organ transplantation is only allowed on a person who is considered dead. The delicate and very complex issue is to determine at what time a person is considered dead and the death of a human being diagnosed by which methods?

Human death is often defined simply as the permanent stop of life's signals. Specifically, the heart stopped beating, the lungs stopped breathing. The invention of the stethoscope in the 19th century, an electrocardiograph in the 20th century, helped to confirm the cardiac arrest.

However, today with the invention of a breathing machine, a pacemaker, the signals of death as before become precarious and clinical physicians as well as forensic medicine have proposed based on The interaction between the functions of the respiratory, cardiovascular and central nervous system to determine the boundary of death.

Death is dead brain?

According to the new standards based on biomedical advances, a human being is considered dead when the activity of the entire brain is deactivated. In clinical practice, the phenomenon of brain death is usually caused by two main causes: The first is the severe injuries or hemorrhage of the brain, which is less common.

Meanwhile, the cause of cardiac arrest interrupts blood supply to the brain, leading to severe cerebral haemorrhage and the resulting brain death is the most common cause, in many diseases and many schools. cardiac arrest.

Thus, the interdependence of the three respiratory, circulatory and CNS systems has been confirmed in every true human death situation. The universal standard of death agreed worldwide by Byrne author is: ' No one is declared a dead patient until the destruction of at least three important systems in the body. is brain, cardiovascular and respiratory '.

Therefore, in the medical field, in addition to the detailed description of the clinical signs that are considered mandatory in order to come to the conclusion that the patient is dead, there are other strict rules such as: the time limit for re-examination until the patient's diagnosis of permanent departure is determined. As in Sweden, a person who is only considered to have died after 30 minutes of active resuscitation or coma does not recover from 6 to 48 hours depending on the cause and age. In Germany, doctors are only allowed to confirm the patient has died after neurological, circulatory and respiratory functions have not recovered over 3 hours.

When the patient is on mechanical ventilation or pacemaker to maintain the functioning of the lungs and heart, a brain death standard is required to make sure that the patient is dead. The diagnosis of brain death is very simple with the help of an electroencephalograph, when there is no occurrence of specific waves for brain activity, which are alpha, beta or delta waves, but just an electric current in throughout the measurement process.

From life to death is a dynamic process and not only takes place in moments, especially in the context of the rapid development of Medicine as it is today. Patients are always assisted by many types of medicines and supportive devices. Therefore it is difficult to assert that life ends and the patient begins to die?

Legally, there is only one death and must be the same for everyone, every case. On the other hand, the procedures for confirming the death of a patient may vary depending on the circumstances, especially at the discretion of the family and medical community to determine if the victim's organs are removed for transplant to another person. is not?

The brain is very important in maintaining the consistency of the nervous system and brain tissue is the most sensitive tissue when hypoxic. In fact, the lack of oxygen for about 5 minutes is the permanent death of brain tissue without recovery. So even if the patient died of apnea or previous cardiac arrest, the brain cells died. In some cases, though the brain is dead. but the heart and lungs are still active, still providing blood for organs such as kidney, liver, cornea . then the use of these organs for grafting is very good.

In general, the brain death standard in confirming one's death is an inevitable result of the development of science and technology, more precisely a progress in diagnosis of death, not a New definition of death. In other words, brain death is not another death.

There are two causes of death

Of the two causes of death, the number of previous brain deaths is very low compared to previous deaths. According to emergency centers in the US, up to 92% of patients die of cardiac arrest first and only 8% of patients die from brain damage.

The current determination of brain death in many developing countries such as Vietnam is mainly for physicians and patients' families to know when they have the right to stop supporting treatments and medicines. In fact, because there is no law on organ transplantation, there are few or only a few cases related to the removal of organs for transplantation. Taking organs and organs when the brain is dead and the heart is still beating is best for organ transplant surgery.

Previous cases of cardiac death, to this day are very unsuitable for organ transplants. Because of the vitality of internal organs, especially those sensitive to oxygen deficiency such as kidneys, cornea . will disappear quickly when blood flow is no longer available.

Assoc. Prof. NGUYEN HOAI NAM