Can we someday prevent brain death?
“It is permanent,” I tell them.
“Once the brain dies…by law, the patient has died and we have to disconnect him.”
As a critical care specialist, I have had this conversation more times than I care to recount. It is always a tragedy — frantic accident, unpredictable brain hemorrhage, and sometimes even suicide. The end result is always the same: the brain dies, I declare the patient “dead by neurologic criteria,” and the patient is disconnected from life support (and invariably dies minutes later).
Yet, does it always have to be this way? New research suggests maybe not.
Researchers have reported in the prestigious journal Nature that they have been able to restore the molecular and cellular functions of dead pig brains hours later:
…we describe the restoration and maintenance of microcirculation and molecular and cellular functions of the intact pig brain under ex vivo normothermic conditions up to four hours post-mortem.
The researchers developed a solution that they pumped into dead pig brains and demonstrated “preservation of cytoarchitecture; attenuation of cell death; and restoration of vascular dilatory and glial inflammatory responses, spontaneous synaptic activity, and active cerebral metabolism in the absence of global electrocorticographic activity.”
Duke University bioethicist and law professor Nita A. Farahany was quoted by the NY Times as saying:
“We had clear lines between ‘this is alive’ and ‘this is dead.’ How do we now think about this middle category of ‘partly alive’? We didn’t think it could exist.”
Now, this is very preliminary research, and much more needs to be elucidated about this trailblazing discovery. And the NY Times article delved into the many ethical and legal implications of this research.
I must admit that, when I first read the headline, I thought that they “revived” pig brains after they had died. And, indeed, they did restore cellular functions up to four hours after they brains had died. That does not mean, however, that the pigs attached to those brains — if the brains were still attached — would wake up after brain death.
Still, for me, as a bedside clinician in the ICU, this preliminary research is very exciting because it may mean that we can save brains that we had previously thought were so injured that they were beyond repair.
I could envision one day using this solution on a patient who has suffered a cardiac arrest — where every minute of no blood flow damages more and more brain tissue — to protect the brain and prevent brain death. The same is true with acute stroke and traumatic brain injury.
Yet, does this mean that we can “revive” patients after brain death? I don’t think so. One thing I have learned as a Critical Care physician is that — sometimes, despite my absolute best effort — our patients will die, and other times, they will survive even though all the “numbers” say that they will not.
Life and death are not in my — or any other clinician’s — hands. I do the best I can — buoyed by amazing scientific advancements such as this one — and fight my hardest to treat their devastating critical illness. And thank God, the vast majority of the time, we are successful. The joy this brings to me is truly indescribable.
The opinions expressed in this post are my own and do not reflect those of my employer or the institutions with which I am affiliated.