Cerebral death: from the fear of premature burial to the myth of the living donor.

Fernando Pita, Cátia Carmona


To analyse the historical evolution of the clinical concept "brain death", and discuss the concepts: whole-brain death and brainstem death in clinical perspective.Taphophobia means the fear of premature burial. Its modern equivalent is the fear of organs harvested from a still living patient. The debate remains concerning the advantages and disadvantages of whole-brain death and brainstem death concepts.We have made a Pubmed-medline and Google search and identified published articles dealing with brain death, brainstem death, whole-brain death, death diagnosis, concept and definition.From the classical cardio-respiratory concept, it was a long way to emerge the centralist brain concept. Brain Death is a technical, ethical and legal concept, it appears: 1. For economic reasons and shortage of technical resources, to remove futile care in patients already death. 2. To permit the provision of organs to transplantation. The clinical criteria demonstrating irreversibility are identical for both, whole-brain death and brainstem death.The concept of brain death appears by technical need, when we have technological substitutions of other organs. Neurological criteria for determination of brain death are well settled, rigorous and reliable. Brainstem death and whole-brain death are both legal and philosophical concepts, without any difference in technical execution.

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