The brain-death establishment discounts such stories as “anecdotal,” as if they were taken from the National Enquirer. But these three cases appeared in Anesthesiology, the journal of the American Society of Anesthesiologists, which has 44,000 members.
The Harvard criteria state that the brain-dead patient must exhibit no movement. Van Norman, however, points out that some exhibit spinal automatism, a complex spectrum of movements including flexion of limbs and trunk, stepping motions, grasping motions, and head turning. Dr. Gregory Liptak, in the Journal of the American Medical Association, wrote: “Patients who are brain dead often have unusual spontaneous movements when they are disconnected from their ventilators.... Goose bumps, shivering, extensor movements of the arms, rapid flexion of the elbows, elevation of the arms above the bed, crossing of the hands, reaching of the hands toward the neck, forced exhalation, and thoracic respiratory-like movements... These complex sequential movements are felt to be release phenomena from the spinal cord including the upper cervical cord and do not [emphasis author’s] mean that the patient is no longer brain dead.”
One cannot determine with certainty what organ donors feel, if anything, while being harvested. The logic of brain death goes like this: If the brain stem is dead, then the higher centers of the brain are also probably dead, and if the whole brain is
dead, then everything beneath the brain stem is no longer relevant. Since in practice only the brain stem is routinely tested, the vast majority of the body, everything above the brain stem and everything below, no longer counts as human.
The reason for denying beating-heart cadavers anesthetic during the removal of their organs is hard to pin down. (Some experts say it is because anesthetic will harm the organs.) Nevertheless, administering anesthetics to BHCs during organ harvests is becoming more common in Europe, according to Robert Truog, professor of medical ethics, anesthesia, and pediatrics at Harvard Medical School. Despite their strong opposition to brain death, Truog and Shewmon both refuse to acknowledge the possibility that some donors may be in severe pain during organ harvests, even though they acknowledge that some donors did exhibit reactions similar to inadequately anesthetized surgical patients who afterward reported pain and consciousness. Shewmon said the donor reactions were simply “bodily reactions to noxious stimuli.” I asked if an experiment could be designed to answer the question of pain in donors. He said no.
Truog did not even want to discuss the possibility of pain in the organ donor. But when I suggested experiments along the lines suggested by other anesthesiologists—when BHCs show pain reactions during a harvest, administer anesthetic to see if the reactions subside—he surprised me by saying he had already done this. He has used two different kinds of anesthetics that do not harm organs to quell symptoms such as high blood pressure or heart rate. “Just because the symptoms come down, though,” he added, “does not mean the patient is in pain. Pain is a subjective thing.” As with Shewmon, I asked Truog if an experiment wasn’t called for. He said there was no experiment that could answer the question of pain in the donor.
Beyond pain, there are many surprising findings in a 1971 paper, “Brain Death: A Clinical and Pathological Study,” published in the Journal of Neurosurgery. The Minnesota team that produced that article studied 25 moribund patients, conducting autopsies on them all and EEGs on some. They also checked for reflexes and found something unusual. Five of the 25 brain-dead people were still sexually responsive. The researchers gently stroked the “nipple and areola” of all patients and got responses from five, four men and one woman. Then they stroked the skin at the root of the penis on the 18 male patients, and four responded with “gentle seesaw movements of the penis.” The researchers felt this reaction was “an incomplete or abortive form of penile erection.” Abortive or not, to the untrained eye it would appear to be a sign of life.
More dramatic are brain-dead pregnant women. The first recorded case occurred in 1981 when a 24-year-old woman, 23 weeks pregnant, was admitted to the Women and Children’s Hospital of Buffalo. After 18 days her EEG showed no cerebral activity and she was transferred to a maternity hospital. A day later she was declared brain dead, approximately 25 weeks pregnant. So she was dead but still pregnant, and doctors decided to use her body—technically it was a corpse—as an incubator. The task was not easy. She developed diabetes insipidus, sinus tachycardia, and uterine contractions. Later she had wide fluctuations in blood pressure, and the fetus’s heart rate was dropping. A cesarean section was performed immediately, delivering a 2-pound “vigorous” baby girl at about the 26th week of gestation. Three months later the infant was discharged from the hospital, weighing about 4.4 pounds.
Six months earlier, another pregnant woman in desperate straits was admitted to the same hospital, with a very different ending. The doctors discontinued life support short of brain death as the fetus was 19 weeks old, and the medical staff accepted the belief that a body could not survive long after brain death was declared. There was theoretically not time to gestate the fetus another 3 weeks, 22 weeks being the earliest a viable baby can be delivered.
More brain-dead pregnant moms followed. As of this writing there have been 22 published reports from around the world, including Brazil, Germany, Ireland, New Zealand, France, Finland, Korea, Spain, and the United States. From these 22 brain-dead mothers, 20 babies were produced, with no remarkable side effects in the infants. One woman gestated a fetus for 107 days after declaration of brain death.
The real significance of pregnant brain-dead women is that they would seem to sound the death knell for brain death as a definition. As Shewmon and many others have pointed out, what is more indicative of life than gestating a baby to a live and viable birth? Keeping a pregnant mother and baby “alive” for 107 days at the very least puts the lie to the theory that the brain dead will go quickly to conventional heart/lung death. At first, brain death advocates said this is a matter of hours. Then they said 3 to 5 days at the most. Then 7 days, then 9 days, then 14 days. Now we are talking about a brain-dead mother not only hanging on for 107 days but nourishing a baby as well.
A final note: Brain-dead mothers can still donate their organs. And so, after suffering a neurological catastrophe, being declared dead, still having to endure several weeks of pregnancy, then giving birth via cesarean section, the patient can still be rolled off to have her organs removed. A woman’s work is never done.
Excerpted from The Undead: Organ Harvesting, the Ice-Water Test, Beating-Heart Cadavers—How Medicine Is Blurring the Line Between Life and Death by Dick Teresi. Published by Pantheon Books, a division of Random House. Copyright © 2012 by Dick Teresi. Excerpted by permission.