Summaries / Resúmenes - Studia Moralia

IS THE BRAIN-DEAD PATIENT REALLY DEAD? 299duce abnormally large volumes of dilute urine. 61 Since the brainis the only source of the hormonal regulator responsible for preventingthis type of diabetes, BD patients without diabetesinsipidus still manifest brain function. Next, many patients whofulfill the tests for brain death (20% in one study) continue toshow electrical activity on the EEG. While there is no way todetermine how often this electrical activity represents true“function” (which would be incompatible with the criterion forTBD), in at least some cases the activity observed seems fullycompatible with function. 62 Finally, clinicians have observedthat BD patients frequently respond to surgical incision at thetime of organ procurement with a significant rise in both heartrate and blood pressure. This suggests that integrated neurologicalfunction at a supraspinal level may be present in at leastsome patients clinically diagnosed as TBD. 63 These studies showthat most patients who have been clinically certified as braindeadretain some brain function. Furthermore, as Dr. RobertTruog has convincingly argued, empirical work has shown thatit is practically impossible to develop clinical tests that candetermine that total brain function has been lost. A study of over500 patients with both coma and apnea showed that “it was notpossible to verify that a diagnosis made prior to cardiac arrestby any set or subset of criteria would invariably correlate with adiffusely destroyed brain.” 64 In other words, one can never clinicallydiagnose the total loss of brain function. BD patients willalways show some residual brain function.But if BD patients will always show some residual brainfunction, which functions are relevant for the diagnosis of TBD?61Kristen M. OUTWATER and Mark A. ROCKOFF, “Diabetes InsipidusAccompanying Brain Death in Children,” Neurology 34 (1984): 1243-1246.62Ernst RODIN et al., “Brainstem Death,” Clinical Eletroencephalography16 (1985): 63-71.63For instance, see D.J. HILL, R. MUNGLANI, and D. SAPSFORD,“Haemodynamic Responses to Surgery in Brain-Dead Organ Donors,”Anaesthesia 49 (1994): 835-836.64Gaetano F. MOLINARI, “The NINCDS Collaborative Study of BrainDeath: A Historical Perspective,” in U.S. Department of Health and HumanServices, NINCDS Monograph No. 24. NIH Publication No. 81-2286 (1980):1-32. Cited in Truog, “Is it Time,” p. 30.