Talk:Brain death

February 2003

Right now, this article has a tautology: "permanent" cessation of EEG activity is not reversible: well, that's true by definition.

Question: can brain electrical activity ever cease reversibly? What about deep anaesthesia, or hypothermia? The Anome

See the ECT article for one possible answer: does anyone have a cite for this? — Preceding unsigned comment added by 217.158.106.57 (talk) 12:48, 27 March 2003

Propofol brings about a dose-dependent diminution of cerebral blood flow, decreases global cerebral metabolic rate, and is potent enough to create a flat electroencephalogram in high doses. This state is rapidly reversible with no neurologic change thereafter.

"Brain death" cannot be diagnosed (by EEG) in the presence of such EEG-dampening drugs. - Nunh-huh 19:19, 31 Mar 2004 (UTC)

irreversibility of brain death

I revised the page fairly extensively, no offense intended. I am a practicing transplant surgeon and know quite a lot about the topic. The key point I would like to make is that brain dead individuals not only have lack of brain function, they have actual necrosis (death) of all brain tissue. Thus, profoundly hypothermic people can have flat EEGs but are not brain dead, at least as clinicians use the term. Assessing cerebral blood flow with radionuclide scanning (or, historically, arteriography) is extremely useful and eliminates any uncertainty about whether recovery is possible.

Another important point is that anyone with a neurologic injury severe enough to have any question of being brain dead has a negligible chance of meaningful recovery, even if they still have some respirations or other brain stem function. — Preceding unsigned comment added by 216.202.124.223 (talk) 19:16, 31 March 2004

Necrosis, now that's irreversible. Should we emphasize that as the "true" definition of brain death, with the various types of tests as a way of detecting the absence of necrosis? (ie "brain life") -- The Anome 06:10, 1 Apr 2004 (UTC)

While it is true that flat EEG's can occur in situations where the individual is not "brain dead", it is not correct to say that brain dead individuals have necrosis of all brain tissue. For one thing, brain death can often be determined within 24 hours of whatever event caused the brain death, and that is too soon for necrosis of the entire brain to have ocurred. The important thing to remember is that brain death criteria are present to determine both the complete and irreversible loss of entire brain function. Things like hypothermia and drug intoxication may cause loss of entire brain function for example, but the loss of brain function in these instances is potentially reversible so is not equivalent to brain death. Necrosis has never been a criterion for determining brain death. — Preceding unsigned comment added by Drsyme (talk • contribs) 21:42, 6 December 2005

It is incorrect that brain death indicates true death. Zach Dunlap was found brain dead, even according to a PET scan, yet recovered successfully, without lasting impairment more severe than memory loss. [1] —Preceding unsigned comment added by 68.183.229.168 (talk) 04:01, 25 March 2008 (UTC)

I think the Zach Dunlap story is incorrect, or at the very least unsubstantiated. All references to it seem to draw from the same feelgood newspaper story (light on medical detail). It is not unlikely that a doctor or, more likely, a journalist made a mistake, so it is weak evidence against brain death being true death. I suggest that the reference is removed until/if a report appears in a peer reviewed form (if he really recovered from brain death there is bound to be a case report soon!) Anders Sandberg (talk) 03:00, 26 March 2008 (UTC)

Possibly, but the father specifically remembers seeing a PET scan that showed no blood flow. According to Professor Bruce Brew, head of the Department of Neurology at St. Vincent's Hospital in Sydney, "It can be difficult to diagnose brain death. There is no absolute diagnostic tests. [sic] ... perhaps one in several hundred thousand [are mispronounced dead]. If not even rarer. By and large when people are pronounced brain dead, they unfortunately, are." [2] —Preceding unsigned comment added by 68.183.229.168 (talk) 18:47, 26 March 2008 (UTC)

I tend to agree with Anders Sandberg on this one. The newspaper story is light on medical detail, and there hasn't been any more substantiation of a true false positive on the brain death study in this case. To add additional nuance, both the news story and the cited blog from the Neurologist refer to the study as a 'PET' scan, when in fact brain death studies are usually scintigraphic or SPECT imaging, not PET. 107.203.117.55 (talk) 03:30, 11 October 2022 (UTC)

Confusing Term

Another ambiguity is the use of the term "brain dead individual." If someone is brain dead they are legally dead. Once a person dies they are then a corpse and no longer an individual. This is not a trivial matter as the entire concept of brain death does not at all address the issue of what it means to be alive or dead, but is just a list of criterion to determine irreversible loss of entire brain function. It is clear to me that society has not accepted the concept of brain death as equivalent to dead because of the use of phrases such as this one.

This article needs a complete rewrite. — Preceding unsigned comment added by Drsyme (talk • contribs) 21:48, 6 December 2005

One can have an individual chair, or an individual shirt. The term seems fine for reffering to living or dead or non-animate things. HighInBC 06:36, 2 March 2006 (UTC)

Adjective or noun...? 67.183.243.198 (talk) 07:07, 31 July 2009 (UTC)

Can somebody explain this to me?

My little cousin was involved in a serious motorbike crash and was rushed to the hospital straight after the acccident. They saved his life although he has lost his eyesight and sense of smell. He was concious and abled to communicate with us by kicking his legs. We were told that his chance of surviving was good as he was only young. He was 18 at the time. Sadly, 11 days after the accident, he was pronouned brain dead. The doctors kept him breathing and his heart beat for another day so family members from abroad could come and see him for the last time. We all watched his heart beat dropped to zero by his bedside.

I am so confused and curious... my understanding was that his brain was functioning when he was at hospital, what has changed? What has made his brain decided to stop working? — Preceding unsigned comment added by 219.79.23.105 (talk) 12:42, 20 April 2006

-A reply- Without knowing the exact circumstances of the case it is difficult to be specific, however, brain death (or brain stem death) can be caused by a whole variety of things, including trauma, bleeding into the brain or brainstem, infection or lack of oxygen/blood supply to the brain or brainstem. I appreciate that he was conscious and communicative for some days before his death, but some of the above factors can cause brain death even weeks after the original accident. If you really want to find out more I suggest you speak to the doctor(s) caring for your cousin, they are usually very approachable and understanding. I am sorry for your loss.Mmoneypenny 21:09, 21 September 2006 (UTC)

-reply- You mention that "the doctors kept him breathing". Does this mean the doctors put your brother on a life support system? I am imagining that the doctors "pulled the plug" in this scenario. Can you please clarify that statement? — Preceding unsigned comment added by 68.193.139.207 (talk) 10:16, 25 July 2007

Other thoughts

In earlier times cessation of respiration and heartbeat used to tell dead or not and a common man could determine that too. Now with science all of this support the various definitions of death make it almost impossible to conclude whether the LIFE is there or not. — Preceding unsigned comment added by 210.7.132.72 (talk) 07:00, 29 August 2006

It's because there is no such thing as "life". There is only a collection of parts that fail. Defining death is a matter of picking which failed parts, typically the heart or the brain, justify giving up and letting everything else fail. 76.169.201.183 21:53, 14 January 2007 (UTC)

A.K.A. you can keep cells alive while certain parts of the body are dead, it's the sum of the whole that makes "conscious life" possible. However without the brain this isn't possible while the body can still be kept alive by machines performing the tasks the brain normally does, the individual is no longer the person they were when they were consciously alive. They're technically alive, although their brain is dead, this is the subject of debate on whether or not people should be kept alive or not because the recovery of brain cells and such is very poorly understood as it is a very long and complex process. The irreversibility factor is difficult to assess but severely extensive damage is usually justification enough. Just some thoughts... 70.162.43.130 06:58, 20 March 2007 (UTC)

Springclean

Wow, yeah we need a springclean here. Now if only I can find some time... I'll come back end of December and see if I can't lend a hand.Mmoneypenny 21:36, 21 September 2006 (UTC)

Just some thoughts post a long day in ICU!

This paragraph could be confusing to the lay-person: "Note that brain electrical activity can stop completely, or apparently completely (a "flat EEG") for some time in deep anaesthesia or during cardiac arrest before being restored. Brain death refers only to the permanent cessation of electrical activity. Numerous people who have experienced such "flat line" experiences have reported near-death experiences, the nature of which is controversial."

The typical use of "flat-line" refers to the ECG or the lectrical activity of the heart not the brain (EEG). In the vast majority of anaesthetic cases one monitors the heart and not the brain.

Also, in the ICU I work in the diagnosis frequently goes to a 4 vessel cerebral angiogram to make fully sure that there is an absense of flow. This is the "gold standard" of brain death. Frequently a person which such massive injuries as to cause brain death will have multiple cranial nerve palsies which makes cranial nerve testing unreliable.

One final thought - I think it should be made more obvious that pronouncing a patient "brain dead" is only required to allow for legal organ donation. If donation is not an option then life-support can be withdrawn without confirming brain death if the hope of any meaningful recovery is lost.

Sorry I have no idea how to edit this myself! 220.245.182.82 11:45, 7 October 2006 (UTC)Jamie

May 2008

Could the next competent medic (preferably British or with an understanding of the British criteria) to check this page please have a look at the Brain Stem Death page too. At the moment, half of it still reads like a rant from the "cardiovascular death only" lobby. 11:02, 4 May 2008 (UTC) —Preceding unsigned comment added by Tharyps (talk • contribs)

Artificial brain

Critics of the notion of brain death have sometimes argued that it could be invalidated by the futuristic existence of artificial brains, given that death in its broadest definition involves the entire body and that it happens on the cellular level, and not on any peculiar mnemonic level. Hence, if your brain unexpectedly dies, it might be replaced by one of these organic computer brains that would maintain your previous state of psychological consciousness, as one would store information on a computer disk. ADM (talk) 07:07, 25 August 2009 (UTC)

NPOV

This article needs to include criticism of the "brain death" criteria and discussion of alternative criteria for death. One prominent author here is Dr. Alan Shewmon. Also, in the religious section, I'm reading about "the lord Buddha" and just imagining the outcry if someone wrote "the lord Jesus Christ" in a Wikipedia article, so I've removed "lord" and cleaned up those sentences a bit. JKeck (talk) 01:51, 11 July 2013 (UTC)

Spelling of "brain dead": with or without hyphen

This page currently uses both "brain dead" and "brain-dead". Which is more correct, and if neither, can we standardize. Zargulon (talk) 16:16, 6 December 2013 (UTC)

Neither is incorrect, but we can standardize on the hyphenated style (brain-dead) for the reasons that are explained at English compound > Hyphenated compound modifiers regarding permanent compounds versus temporary compounds, because both AHD4 and M-W Collegiate online enter both hyphenated brain-dead (adj) and open compound brain death (noun). I'll go edit to suit. Done. Quercus solaris (talk) 20:58, 6 January 2014 (UTC)

January 2014

Wikipedia cited: In spite of Wikipedia's willingness to deny itself as credible.
Wikipedi was used as a resource to define 'Brain Death' or 'Brain-Dead'
to competent medical and civil authorities.
'Brain Death' or being 'Brain-Dead' is specifically:
Necrotic tissue or dead tissue within the brain.
Tissue which cannot support life.
The lack of detectable brain electrical activity did not support Brain Death alone. — Preceding unsigned comment added by 108.89.36.16 (talk) 19:16, 6 January 2014 (UTC)

The current version of the lede very concisely makes it very clear that the operational definitions of the term vary depending on who defines it. Therefore, it really doesn't matter who reads this article (including "competent medical and civil authorities"), because this article cannot tell them to favor one operational definition over another, and the article explicitly explains that fact to them up front. It can mention various specific references' operational definitions (and it does), but it can't pick one as "the winner" (and it doesn't try to). Anyone whose reading comprehension level is so low that they could look at this article and fail to understand those facts can't really be helped by anything short of intensive remedial education. Quercus solaris (talk) 20:18, 6 January 2014 (UTC)

Is necrosis necessarily a condition for brain-death? I think it confuses the lede. Is necrosis always found upon autopsy of brain-dead patients? I don't believe that it would be.24.0.133.234 (talk) 00:13, 4 March 2014 (UTC)

Lack of oxygen leads to cell death which is necrosis, a medical term with a specific definition. If all brain cells (aka neurons) stop receiving oxygen, all of them will undergo necrosis. The initial changes to the cells will be small and not necessarily seen on autopsy, but that doesn't mean that necrosis hasn't occurred. Ca2james (talk) 15:57, 4 March 2014 (UTC)

Sorry Ca2james, but I am really not comfortable with "necrosis" -(and yes i know what that is lol), being given in this article/lede as a criteria for brain death. The definition of legal brain death criteria and tests for that have been established, and necrosis does not factor-in in most cases from the way that I understand it.

Since the (incorrect imo) word has remained in the article for some time now, I am hesitant to change it but I will be looking-for references that could support rm of "necrosis".24.0.133.234 (talk) 16:54, 6 March 2014 (UTC)

The term is medically correct. What are your policy objections and what is your suggested re-wording? Ca2james (talk) 17:07, 6 March 2014 (UTC)

Religious views

The section on religious views is a discussion on religious views with respect to organ donation, not brain death. I think this section needs to be re-worked to add religious views on brain death and remove the organ transplantation discussion but I don't really have the knowledge to make this change. Also, I'm a newbie and while I know I should be bold in my edits, I'm reluctant to make such a big change on a section that's been around this long. Ca2james (talk) 17:42, 20 February 2014 (UTC)

Since no one has commented, I moved the religious views subsection to the organ donation section and reworked the first sentence. This maintains the text but stops it from being WP:COATRACK in the Legal history section. The entire organ donation section may still be coatrack text but now it can all be considered together. Ca2james (talk) 15:51, 4 March 2014 (UTC)

Question about removed text

24.0.133.234, why did you remove the sentence, "Most organ donation for organ transplantation is done in the setting of brain death."? Ca2james (talk) 02:53, 6 March 2014 (UTC)

In the same vein, 24.0.133.234, re your edit note: "this is true. Please stop deleting everything that is not cited-just tag it if you must." - No, I will not just take your word that something is "true" if a) there is no citation or b) your edit is not borne out by the cited reference(s). Stop making unsourced claims. This is an encyclopedia, not your personal soapbox. Funcrunch (talk) 06:13, 6 March 2014 (UTC)

Ca2james I wholly deleted that statement because I don't believe that it is correct. The only other place that I have seen that statement (worded like that) was in a ref. to an About.com article and that article had no reference. LIVING people for instance donate organs for organ transplantation (kidneys mainly?), all day every day. I did not want to CHANGE that sentence, but we just don't have the references and statistics to back it up and are we talking USA-or globally? In Japan, I think I saw figures as high as 90-something per cent of organ transplant is from a living or clinically dead donors--(from how I recall don't consider that as fact).

Trying to FIND the correct statistics is a little tricky because in the US for instance, when they say, "cadaver donor"-they mean brain-dead/someone on a ventilator. So they show statistics between brain dead donors and living donors, when talking about kidney transplants for instance, but there is basically NO SUCH THING as a heart transplant from a living donor, permanently clinically dead (corpse-a "real" cadaver imo)...

I resent the rhetorical tricks-(see below), and politically correct language that has crept into this medical/scientific topic. Using the choice of terms which we are increasingly being led to use,(and actually must use for accuracy even if they mean the OPPOSITE of what they really mean) is beginning to look more like BS of the most disgusting Orwellian variety because it has to do with people's innate rights as human beings. Why should WP go-along with that agenda? WP should HELP people sort it all out not promote this Doublespeak 24.0.133.234 (talk) 15:29, 6 March 2014 (UTC)

I think I discussed this below so I'm going to reproduce here what I said there. "It is true that most organ donation, aside from kidneys, is performed in the context of brain death. The fact that the reference is poor means that we need to find a better reference but the sentence should be restored (perhaps with the modification about kidneys) with a cite needed tag. As well, the fact that most organ donation does take place in this context means that it is reasonable to include a brief summary of the main article." I'd like to add that hearts and lungs can only come from someone who is brain dead.

I think there must be other references for this statement, possibly that use other language; I do agree that an about.com article isn't the best reference. Ca2james (talk) 16:12, 6 March 2014 (UTC)

Organ Donation?

Why is there a section on Organ Donation (and religious views on organ donation) in this article? Seems like it would maybe be better to simply have link to the Organ Donation WP and discuss such issues over there --BoboMeowCat (talk) 05:07, 6 March 2014 (UTC)

I agree. There are even sections on brain death and religious views on that page already. Funcrunch (talk) 05:13, 6 March 2014 (UTC)

Also, this (reverted) edit by 24.0.133.234 was quite blatantly not NPOV. Funcrunch (talk) 06:29, 6 March 2014 (UTC)

I think that there is too much unrelated organ procurement and transplant information in this article as well. The sub-topic does belong maybe as views and opposing views on why the topics are related or maybe just why the topics are related if that is possible?24.0.133.234 (talk) 14:57, 6 March 2014 (UTC)

And you know what Funcrunch- I thought that the topic was going off-track with all of that business about driver's licenses, (I did not start that just added more references and corrections) but as it turns out, there was some really GOOD information to be found. This "default" affirmative choice for organ donation on DLs CAN have an impact on whether or not someone is even resuscitated, or even started on mechanical ventilation, which has a great deal of relation to brain death diagnoses.

I think the DL ifno. should be moved to organ donor, and WHY would a TED talk which also included a(nother) reference to the source of a psychological study which points out that NOT giving people an option to plainly say -N-O- to organ donating (by using techniques and device of mental illusion and confusion with the negative choice meaning an affirmation to donating)....why would you want to CENSOR that as NPOV? I don't understand. Censoring and only presenting YOUR ideas is where NPOV slant occurs.24.0.133.234 (talk) 15:12, 6 March 2014 (UTC)

A discussion of the psychology of how people perceive and make their choices based upon the wording of a question belongs in an article on that topic. It is true that most organ donation, aside from kidneys, is performed in the context of brain death. The fact that the reference is poor means that we need to find a better reference but the sentence should be restored (perhaps with the modification about kidneys) with a cite needed tag. As well, the fact that most organ donation does take place in this context means that it is reasonable to include a brief summary of the main article. I haven't read the organ donation page closely but I suspect that this section doesn't adequately summarize it and needs work.

I agree that the info about who opts in/opts out of organ donation and how they do it (there's much more to this than driver's licences) belongs in the main article on organ donation, not here. I also agree that the religious views on organ donation belongs in the main organ donation article as a summary of its main article (I don't know if its an adequate summary, either). Finally, I think that there's a place in this article for a discussion on religious views with respect to brain death, which is missing. Ca2james (talk) 16:01, 6 March 2014 (UTC)

24.0.133.234 (talk), it was your wording that I take very strong issue with. "Organ recovery advocates have used psychological confusion to promote donation" (emphasis added) is clearly not NPOV, nor does it accurately reflect what was said in the TED talk you cited. It is stating your personal opinion about what the source means. Your opinion is original research, and it is not censorship to require you to include only what the sources actually say in this article. If the TED Talk included another reference with a psychological study then include a cite to that reference and word your edit in a neutral way.

I strongly suggest that you (re)read Wikipedia's policy on NPOV, along with this essay on verifiability before either making any further edits or accusing others who challenge your edits of "censorship". Funcrunch (talk) 17:15, 6 March 2014 (UTC)

I used my own wording because that is what we are supposed to do on WP. I also provided the exact quotation so that readers could see the difference. You had an objection about the "overly long quote"-being used, so which is it? Well-what would you have me do? Copy word for word? In this case I used the word "confusion" to describe the quoted "intentional illusion" of choice that is being given. That was in good faith and but it was intended to show that SOMEONE there obviously had an AGENDA to obtain a MIS-INFORMED (therefore invalid actually)-"donor consent"-ok?24.0.133.234 (talk) 18:18, 6 March 2014 (UTC)24.0.133.234 (talk) 18:19, 6 March 2014 (UTC)

I do not believe you are editing in good faith. Your edits on this and other articles have shown a clear pattern of bias and an attempt to advance your own viewpoints under the ruse of providing a "neutral point of view". You have been warned of disruptive editing numerous times over the past year. Once again, this is an encyclopedia, not a place for you to advance a personal agenda. Funcrunch (talk) 18:34, 6 March 2014 (UTC)

The psychological confusion text was definitely not WP:NPOV. Regardless, the subject matter doesn't belong here at all as this is a discussion of brain death and (nominally) organ donation, not the psychology of choice, and is therefore WP:COATRACK. Ca2james (talk) 19:15, 6 March 2014 (UTC)

Oh please-I did not bring up that driver's license business in the 1st place. The fact that people are being psychologically manipulated into "choosing" to be a donor DOES apply once THAT is discussed. How could it not belong?24.0.133.234 (talk) 15:02, 7 March 2014 (UTC)

I don't think the DL part belongs here at all but should be included in the larger article on organ donation. The psychology of choice is a larger discussion that should live over at another article and could possibly belong as a subsection on organ donation. By giving that discussion space (and therefore weight) here, that section is coatracking. Moreover, your specific words don't belong because phrasing like "psychologically manipulated" isn't neutral. Do you have suggestions for including this that doesn't give it undue weigh and that is neutral? Ca2james (talk) 17:27, 7 March 2014 (UTC)

I don't think the entire Organ Donation section belongs here at all. Does anyone currently working on this section have argument as to why this content belongs here on this page, rather than over on the Organ Donation page --BoboMeowCat (talk) 01:10, 8 March 2014 (UTC)

I was going to say that it belongs here because most organ transplants take place in the context of brain death, but then I realized that this is an argument for the Organ Donation main page to talk about brain death, not the other way around. Therefore, I support the removal of the Organ donation section on the brain death page. Ca2james (talk) 16:27, 8 March 2014 (UTC)

I have no issue with removing the Organ donation section but I don't think that it should then be mentioned in the lede, which is supposed to be a summary of the article. I dont know where the material should go but it isn't the lede. Note that I also disagree with the wording (does the dead donor law really need to be mentioned in an article on Brain death?) but I'd rather see it find a good home before discussing how it could best be changed. Ca2james (talk) 00:01, 9 March 2014 (UTC)

Added the "dead donor rule" because it seemed a brief, NPOV and referenced version of some of disputed content 24.0.133.234 has been adding. Maybe it better belongs on Organ Donation page, but not sure, because brain death is the reason such donors qualify to donate. I don't have any problem with the organ donation content being moved out of the lede. Only added it there because that is where the original unreferenced content was located. Just think it should be briefly mentioned somewhere, with a link to appropriate page, instead of being a lengthy section of its own on this article. --BoboMeowCat (talk) 02:29, 9 March 2014 (UTC)

I disagree that it's NPOV because a devastating neurological injury is not the same thing as brain death. Neutral language uses the correct medical terms. Either way, according to WP:LEAD, "The lead serves as an introduction to the article and a summary of its most important aspects." So if organ donation -let alone the dead donor rule- is not mentioned in the text, it doesn't belong in the lead. Therefore, I'm going to remove that addition. Done. Ca2james (talk) 04:36, 9 March 2014 (UTC)

I agree that organ donation should be mentioned in the article, but not in the lead and not with that phrasing. Something in the history section might be best, if we talk about the history of brain death and how while organ donation didn't cause brain death to be introduced (there is a reference for this), but brain death made donation of organs more easily done. Ca2james (talk) 04:32, 9 March 2014 (UTC)

"devastating neurological injury" actually wasn't my paraphrase, but rather the exact phrasing from the Critical Care Medicine journal article referenced (which seems reliable peer reviewed medical source). Personally, I think brain death qualifies as a devastating neurological injury, but all devastating neurological injuries don't qualify as brain death. I have my own ideas about brain death, as I'm sure all the editors here do, but I'm not adding that, instead I was basically just trying to add some referenced content (and present this content as it was presented in the referenced source) because this article seems currently largely unreferenced.--BoboMeowCat (talk) 04:52, 9 March 2014 (UTC)

I appreciate what you were trying to do; you seem to have a knack for finding compromises between different viewpoints here. I see your point that brain death includes devastating neurological injury but not vice versa. My concern is that because it isn't vice versa, the language could be misinterpreted. I can't read the article so I can't speak to the terminology used there. Is there a newer article that directly addresses the subject of brain death and organ donation that is freely available? I am still wondering if a mention of organ donation could be made towards the end of the Legal History section, possibly without specifying the dead donor rule. I'm not sure how to insert that statement, however.

On the subject of references, one decent paper that outlines some differences in determining brain death between the US and UK is here. There's this historical review, too. Ca2james (talk) 19:27, 9 March 2014 (UTC)

Undone/Removing vital organs cause clinical/cardiac death but since legal brain death has been established, cause of death is noted as whatever caused the state known as brain death and date of death is generally listed as the date upon which brain death

I added a little more, but why was this deleted in the 1st place. Deletion undone pending discussion here please. Is it always mandatory to included cite? A tag would save content better imo. This was my edit to the article on January 17 and about a month later it was removed here---> http://wiki.riteme.site/w/index.php?title=Brain_death&diff=next&oldid=59446874924.0.133.234 (talk) 16:41, 6 March 2014 (UTC)

The statement is WP:OR, is false, and has no references. You are inappropriately expressing causality where none exists and weaseling a definition. Brain death is legal death and cause of death is whatever caused the legal death. The statement doesn't belong on wikipedia. Ca2james (talk) 17:03, 6 March 2014 (UTC)

Yes, it is always mandatory to include citations. This is an encyclopedia, not a discussion forum. See the essay on verifiability I posted above. Funcrunch (talk) 17:18, 6 March 2014 (UTC)

So are you saying that WP:VERIFY is incorrect? Information must be "verifiable". Please do not post broadly incorrect WP policy information that is not in line with the project goals.24.0.133.234 (talk) 19:57, 6 March 2014 (UTC)

No, I am not saying that WP:VERIFY is incorrect; quite the opposite. The essay on verifiability I linked to is found as the first footnote on the WP:VERIFY page. Funcrunch (talk) 20:08, 6 March 2014 (UTC)

See also footnote 4 on the WP:VERIFY page: "Zero information is preferred to misleading or false information." Funcrunch (talk) 20:11, 6 March 2014 (UTC)

I fail to see where there is even a problem with this information. Any facts and statements that will help untangle questions that readers have about the topic is appropriate imo, but what references are wanted here? date of death and cause of death--OK, fair enough, this could be another "state's/country's CHOICE", so I accept that verification is needed. (I think in the US it is covered by Federal but not sure so I will make sure and be more precise)

This----->"Removing vital organs cause clinical/cardiac death but since legal brain death has been established"..........um. That is obvious and if a cite is needed no problem with that.But isn't this fact already referenced in the article somewhere? I think the New Yorker blog article which I just added to Further reading, covers the basic idea there. I think that I could nail it down to "Removing vital organs from the brain dead causes clinical/cardiac death but since legal brain death has been established..." to add clarity.

I will post my references here when I find them24.0.133.234 (talk) 23:15, 6 March 2014 (UTC)

I am dubious about the merits of including an editorial by a psychotherapist as an external link in an encyclopedia article about brain death, but no doubt you will cry censorship again if it is reverted, which is getting tiresome. I defer to other editors on this one. Funcrunch (talk) 23:40, 6 March 2014 (UTC)

A blog entry is NOT a reliable source for an encyclopedia and is not an appropriate source for further reading. 24.0.133.234, when brain death occurs, cardiac death follows whether organ are removed or not. The fact that cardiac death occurs after organ transplantation is irrelevant to the article, does not clarify the concept of organ transplantation (which should be a summary of the main article), and does not belong here. Ca2james (talk) 03:08, 7 March 2014 (UTC)

A New Yorker dot com science and medicine blog--and i read the entire article before adding to the section, it was VERY appropriate, WHY NOT LET THE READERS DECIDE?

But secondly, seriously, Ca2james, YOU ARE WRONG. Not yelling in caps to be loud, but to alert you. Where you say, "when brain death occurs, cardiac death follows whether organ are removed or not."---that is just not true. NO reliable source would agree with that-none, since it is W-R-O-N-G/INNCORRECT. You are wrong about that, just wrong and you should know where to ref. that since you are so interested in removing sources? 24.0.133.234 (talk) 15:11, 7 March 2014 (UTC)

A blog entry is not an appropriate external link as per WP:EXT. It is up to you to prove assertions you make. Note that even if you do prove this particular assertion, it does not belong in this article section because this section should be a summary of the main article on Organ donation... and I'm not convinced it belongs there, either, for the reasons I stated above. Ca2james (talk) 16:49, 7 March 2014 (UTC)

Well I'm going to have to agree and disagree with you there. I also have a problem with organ donor info in an article that is supposed to be about brain death, but the topics are explicitly and specifically linked, so there should probably be something, just not undue weight. The additional (more recent), which actually is not OR, the stuff about "date of death"--and "cause of death"---does not really have much to do with this transplant topic, except that a donor declared brain dead, listed as date of death at that time, can be mechanically ventilated for additional days, (and I'm not really sure how long a brain dead mechanically ventilated organ donor could be kept alive, but "normally" it is however long it takes to arrange and prepare for transplant.)---point being that the "date of death" is listed differently than the date that mechanical support was discontinued. "Cause of death"-clinical death and I am not using the term cardiac death because in ♥ transplants the ♥ actually continues to live.... is due to removing the vital organs, and/or removing the mechanical ventilation, BUT-it was found in the UK, where they had imposed a "10 minute rule"----where the plugs were pulled, (causing clinical death),and then waiting for 10 minutes before organ removal that the outcomes were not what they wanted in the patients receiving the transplants...but "cause of death"--would be listed as the brain death, or whatever contributed to that, most certainly NOT the fact that clinical death was directly caused, and was the specific reason for clinical death was termination of life support. ....I really did not want to add ALL of that, and the refs, since there are links to those topics and I thought that the most related to brain death information there is the "date of death", and "cause of death"----items, which I think can be expanded in the article, and need to be expanded.24.0.133.234 (talk) 17:42, 7 March 2014 (UTC)

Also, I FULLY complied with WP:EXT I resent that you would send me there when you cannot see that for yourself. That particular source, I did not choose to use in the article, but it was so valuable to the topic, that I felt that it belonged in external links as per WP:EXT. 24.0.133.234 (talk) 17:51, 7 March 2014 (UTC)

What are your reliable sources for your opinions date of death, cause of death, and brain death? Proving it means to provide reliable sources, not to restate your opinion. As I said previously, this discussion does not belong in this article; if it goes anywhere, it goes in the main organ donation article. Also, by adding a blog as an external link,you did not follow WP:EXT guidelines. Ca2james (talk) 19:02, 7 March 2014 (UTC)

So what is this then? WP:NEWSBLOG I added the external link blog as a service to WP and it's users with this particular policy in mind to improve the WP:EXT. I saw that it was a Science and medicine blog,(on The New Yorker dot com) but I also read the article and it was very informative and the only opinion that I could see-(overall because i did not agree with everything in it)--was that brain death is complicated.24.0.133.234 (talk) 05:33, 10 March 2014 (UTC)

According to WP:NEWSBLOG, "these may be acceptable sources if the writers are professionals, but use them with caution because the blog may not be subject to the news organization's normal fact-checking process." This is a news blog written by a psychologist, not a professional with respect to brain death. This article might be interesting but not every interesting article or fact belongs on Wikipedia.

Do you have reliable sources for your statements about date of death, cause of death, and brain death? Ca2james (talk) 02:50, 11 March 2014 (UTC)

I thought that I added a good source to the article about date of death when brain death is the cause? OK I can't find it now, that's just weird because I did find a source that explicitly stated that and i thought that it had already been added. 24.0.133.234 (talk) 10:46, 12 March 2014 (UTC)

So this ref. states "What is the legal time of death for a brain dead patient?

The legal time of death is the date and time that doctors determine that all brain activity has ceased. This is the time that is noted on the patient’s death certificate."http://www.donorrecovery.org/learn/understanding-brain-death/----I may have added this from my tablet but still I should have been able to find it. I don't know what happened there24.0.133.234 (talk) 10:54, 12 March 2014 (UTC)

References and External links

Looking through the external links, it seems that most do not comply with WP:EXT. There's the link to a list of documents in German, something from the pontiff's office, a link to an essay written for a textbook located online, and others. I'm not sure these links are encyclopaedic enough to be included and propose replacing them with better links.... Except I'm not sure where to find good ones. Should we just delete the section until we find good external links?

Related to this subject are the four bulletted references in the notes section. Since they are not used in the text I don't think they belong there. If they belong anywhere, it's in external links but again I not sure they're encyclopaedic enough. Thoughts? Ca2james (talk) 19:28, 7 March 2014 (UTC)

I'd be in favor of ditching the external links and orphaned references. This whole article really needs a cleanup IMHO, which is why I added the refimprove template and also posted to WikiProject:Death in the hopes of getting more editors to help with this page. Funcrunch (talk) 19:48, 7 March 2014 (UTC)

I also think that section needs to be updated, but instead-of wholesale blanking/deletion, I think that a further reading section may be more appropriate. I also object to WP:EXT being used as an excuse to remove material unless the material is not worthwhile for some reason.

Since my 1st attempt to add a new ref. to that section was challenged, (ha ha I say 1st because yes, I did have an agenda there!)----what my "plan" was, was that since I have been looking-at a lot of these related topic articles, (and finding some of them in need of help), --and also, collecting references that are either not already in the article, but that could help a user learn more about the topic as per WP:EXT-reasons to include external ref......I thought that putting these items in external link or further reading was a good way of sharing information without changing the content of the article.24.0.133.234 (talk) 01:38, 8 March 2014 (UTC)

Whether you add sources in the body of the article or after it, please follow the guidelines that are posted on each medicine-related talk page for identifying reliable sources. Particularly note the section on popular press. Funcrunch (talk) 01:46, 8 March 2014 (UTC)

Please also note that this article is part of the WP project death when researching article guidelines. "Death" and brain death is not just a medical condition, so I'm not so sure that "only" medical sources need to be used here?24.0.133.234 (talk) 02:21, 8 March 2014 (UTC)

If you're writing about coffin-making or funeral rites, then sure, you wouldn't need to cite "only" medical sources for those kind of edits. You and I both know that's not the issue here. Funcrunch (talk) 03:29, 8 March 2014 (UTC)

No I don't know that. I have not looked-at the death portal well enough to know what they say about it,(which I plan on doing asap) but death is a psychosocial event besides just being a clinical term or observation.24.0.133.234 (talk) 16:06, 8 March 2014 (UTC)

I've removed the external links. There's nothing in them that fits the purpose of the section that cannot be in the article instead per WP:ELYES. Here they are in case editors want to look over them for potential sources etc.: --Ronz (talk) 18:08, 11 March 2014 (UTC)

• Brain Death from the Encyclopedia of Death and Dying
• How Stuff Works – Brain Death
• Textbook section
• Why the Concept of Brain Death is Valid as a Definition of Death: Statement by Neurologists and Others and Response to Objections. Pontifical Academy of Science
• An extensible bibliography: „Brain Death“: Alive body – dead person?
• Describing Life to Define Death. MEDICC Rev. 2010;12(4):40.

As far as the unlinked references go, all were added without any corresponding changes to content or other indication of use, with the exception of Karasawa which was added here. I've removed all except Karasawa, which I've linked to the corresponding content. --Ronz (talk) 18:24, 11 March 2014 (UTC)

Religious Views section

The entire section pertains to religious views on organ donation. Even the sub-heading of the section says that. I think it should go or be re-written. There are religious views on brain death but I don't want to go there myself/too complicated.24.0.133.234 (talk) 02:19, 8 March 2014 (UTC)

Yes, and it's a sub-section of the Organ donation section. I moved it there because it was about organ donation and not brain death, as I described above. I agree that it needs to be rewritten to better summarize the main article. Ca2james (talk) 02:27, 8 March 2014 (UTC)

Another question about removed text

24.0.133.234, why did you make edit? What do you think is false about this statement: "If a brain-dead individual is not an organ donor or consent is not given by the legal next of kin, ventilator and drug support is discontinued, circulation stops, and the organs cease to function."? Your edit summary said something about the US but the statement is a general, logical, medical conclusion to what happens if someone isn't a donor. What is your contrary evidence that this statement is not true? Ca2james (talk) 02:24, 8 March 2014 (UTC)

I took the statement out rather than add a whole lot of info that would qualify that statement. In some countries, and states-and/or cases, such as the Jahi Mcmath case, brain dead people are cared-for until the heart permanently stops beating, or a decision by the appointed decision-maker to discontinue treatment(s), or refuse further resusitation-(DNR)...and other options that are available and practiced worldwide.

And again, if we are specifically referring to organ donors or potential organ donors there-does it belong in a brain death article? And if it does, the statement STILL needed to specify that and the condition, or circumstances.

It COULD be a good point in the article, but it just left-out other options making it look like that is/was the case in all instances, everywhere. "What happens after brain death when mechanical and medical support continues" could maybe be a good sub-section, with the options and variations expanded if that is not already in another article which could otherwise be linked?24.0.133.234 (talk) 16:18, 8 March 2014 (UTC)

Organ donation restored

Seems like it might be a bit undue as presented, but it definitely belongs judging by the sources and content, both here and at Organ donation.

The section here could be improved to better summarize the issues, given that the details should be in (and are in) Organ donation.

Is the brief sentence in the lede a good summary? --Ronz (talk) 18:25, 11 March 2014 (UTC)

I think that the use of the term brain death has been evolving. The term has a significant relation to organ donation, but also used as a diagnoses. Sometimes (more recently and I don't know if it is being used correctly in these cases, depending on who is using the term and what they are referring-to) it is used to indicate permanent loss of consciousness with no hope of recovery which results in legal death-even-if organ donation is not involved. Legal death is not required to terminate life support but it is always required to recover organs.(edit to add)24.0.133.234 (talk) 14:33, 12 March 2014 (UTC) from brain dead donors.24.0.133.234 (talk) 14:33, 12 March 2014 (UTC)

There are definitions of areas of brain death which are referred-to with terms like ischemia, or even tumors,necrosis--- such as stroke and other brain-damaging conditions that are not fatal, or not permanent, and recoverable. Any dead part of a brain stays dead from the way that I understand it, but recovery from brain-damage from dead parts of the brain is common. I may try to expand on that in the article with references. I'm not sure if that would be a good idea or how to apply it to the article though? People with these conditions, technically may have some brain death, but they would not be considered legally dead.

The diagnoses of whole brain death or whole brain death including brain-stem Uniform Determination of Death Act(latter means that mechanical ventilation would be needed to maintain respiration), requires clinical observations and in legal deathtype-brain death, requires scientific tests to verify, based-on local policy. Diagnosing irreversible BD, can also prevent futile treatment or assist in a differential diagnoses where brain death is suspected.24.0.133.234 (talk) 11:34, 12 March 2014 (UTC)

To answer opinion of organ donation in the lede, it looks OK to me, but maybe add internal link to legal death?

The opening statement "due to total necrosis[verification needed] of the cerebral neurons following loss of brain oxygenation[verification needed]."---would be more correct if it said, "can be due to..." I'm thinking of crushing accidents/physical trauma24.0.133.234 (talk) 12:01, 12 March 2014 (UTC)

Do you have reliable sources that describe how the term "brain death" has been evolving? The current literature seems to describe brain death fairly rigorously and specifically, and while "irreversible" is used in the definition, it is not used in the term itself.

The organ donation section is a bit of a mess and could use a rewrite; I'm thinking that it would be better to get this section done first before figuring out how to summarize it in the lead. I know I said above that this section should summarize the main article but I think I was wrong on that. I think it would be better to restrict the discuss in that section to organ donation as it relates to brain death.

I think it's fair to start with something like, "Although organ donation does occur after cardiac death or from living donors, a significant proportion of organ donation occurs in the setting of brain death," to establish relevance to the topic of brain death. After that, a brief summary of the history of brain death as it relates to organ donation might be appropriate, followed by the general medical procedure for donating organs. There are articles out there saying that determining brain death (particularly the second test) may have a detrimental impact on the quality of donated organs; perhaps that could be included. I don't think that the organ donation section in the brain death article needs a discussion on how people decide to be brain donors in different countries, opt-in/opt-out systems, or the black market. Thoughts? Ca2james (talk) 17:48, 12 March 2014 (UTC)

Going backwards w/your comments Ca2james, completely agree that further discussion about organ donation should be left out of this article.

(this--->)"second test) may have a detrimental impact on the quality of donated organs; perhaps that could be included."...that is pretty interesting and if this brain death article has a section or paragraph that focuses on the tests used in diagnosing BD, (unless we just defer that to legal BD or somewhere else, but since this article does have an ICD9 box?? I think that we can lean on that pretty heavily), so if the article discusses these medical tests, that could fit and I think it should be included?

.............medical procedure for organ donation/recovery, I think leaving that out or another internal link would be even better....

and finally ""Although organ donation does occur after cardiac death or from living donors, a significant proportion of organ donation occurs in the setting of brain death," to establish relevance to the topic of brain death. After that, a brief summary of the history of brain death as it relates to organ donation might be appropriate,--" ..extremely brief remark about BD and organ donation, again with internal link to maybe a WP article about the Harvard opinion of 1968

.......And finally organ recovery and transplant after cardiac death? WAY-too complicated. (they even have a category of organ and it is called an ECD Expanded Criteria Donor,and we don't even want to get into "controlled cardiac death-do we?-its organ donor specific) as-opposed to brain dead donor who transplant orgs refer-to as "cadaver donors"-(those being the legally brain dead who are mechanically ventilated).

BUT, I think that --->"a significant proportion of organ donation occurs in the setting of brain death" is perfect, and might be ALL that is needed in this article along-with brief mention to transplants/brain death historical relation?

I don't know if the "evolution" of BD is a good idea although maybe something about how the term is used in different contexts and different fields again-sticking to the ICD-9 box might be better and instead of changing or evolution of the term and/or some history pre-Harvard, the Ad-Hoc Harvard committee http://www.ascensionhealth.org/index.php?option=com_content&view=article&id=153&Itemid=172....and then there were some other landmarks/changes like more tests needed and ruling-out hypothermia etc. 24.0.133.234 (talk) 23:06, 12 March 2014 (UTC)

24.0.133.234 (talk) 23:32, 12 March 2014 (UTC)

I think you're right that we don't want to introduce things related to either cardiac death or that (interesting but irrelevant) paper on brain death tests and organ quality in this section because it complicates the article. However, I don't understand what you're asking for in your last paragraph; can you give me a sample of what you're thinking would be a good addition to the organ donation section? Thanks. Ca2james (talk) 17:40, 16 March 2014 (UTC)

OK-I just looked at the organ section, and I would probably just eliminate the part about people in "some places" as being automatically considered as organ donors since brain death only factors-in for the people diagnosed with brain death. That should be on the organ donation article though.

I'm also wondering if the part that I added about DNR and advance directives will stay current or if it still is due to the fact that in some places, a declaration of legal death/brain death should override that? -I don't know if a DNR would cover someone who has already been declared legally dead?--although I have seen references to advance directives such as this confounding efforts to donate organs.

I also really like "a significant proportion of organ donation occurs in the setting of brain death"----but leaving out other quantifiers since references tend to waffle about "preferred"-donor and extracting the data about types of organ donors is an exercise in OR anyways. — Preceding unsigned comment added by 24.0.133.234 (talk) 20:56, 17 March 2014 (UTC)

I agree with those changes and I agree that the DNR stuff doesn't belong on this article. Do you want to make the changes? Ca2james (talk) 00:41, 18 March 2014 (UTC)

Not relatable to actual death?

Is there anyone credible who believes that absolute brain death isn't synonymous with death? There have been people who turned around from this condition, as is mentioned in the article, but I think the very notion is discouraged in the public. Such views are linked with extremism, families desperately hoping against hope, and links to the anti-euthanasia movement. But is there anyone with theories about people returning from 'brain dead' state, or otherwise innovative or explanative thoughts on the problems associated with this concept? --IronMaidenRocks (talk) 12:54, 1 May 2014 (UTC)

Sorry to answer this so late but what i think you are referring-to would be considered a misdiagnoses. At this point, "brain death" is considered to be a final-permanent, irreversible loss of consciousness along-with physical signs and test-results to confirm. People's other vital organs "return" from brain death through transplantation I guess you could say, but although there is debate about misdiagnoses and tests used to determine brain death, (because any repairable or recoverable condition labeled as brain death would be a misdiagnoses)--an irreversible loss of consciousness is what it is.24.0.133.234 (talk) 16:23, 5 September 2014 (UTC)

Bibliography:

Wijdicks, Eelco F.M. "Evidence-based Guideline Update: Determining Brain Death in Adults." Evidence-based Guideline Update: Determining Brain Death in Adults. American Academy of Neurology, 8 June 2010. Web. 22 Feb. 2016.

Busser, Jonathan. "Ectopic Cell Cycle Proteins Predict the Sites of Neuronal Cell Death in Alzheimer's Disease Brain." Ectopic Cell Cycle Proteins Predict the Sites of Neuronal Cell Death in Alzheimer's Disease Brain. The Journal of Neuroscience, 15 Apr. 1998. Web. 22 Feb. 2016.

Laureys, Steven. "THE NEUROLOGY OF CONSCIOUSNESS." Cognitive Neuroscience and Neuropathology. Elsevier, 2009. Web. 22 Feb. 2016.

Xue, Mengzhou. "Intracortical Hemorrhage Injury in Rats." Intracortical Hemorrhage Injury in Rats. Stroke, July 2000. Web. 22 Feb. 2016.

Erin, Charles A. "An Ethical Market in Human Organs." An Ethical Market in Human Organs. JME, 17 Mar. 2003. Web. 23 Feb. 2016.

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Legality

Now that the Jahi McMath case is back in the news, I think a mention of the New Jersey Declaration of Death Act (https://muse.jhu.edu/article/245624) is useful. However I don't know how to present it in context of other states' viewpoints, so someone more versed in these topics should add it in. Wqwt (talk) 19:19, 29 June 2018 (UTC)