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Several countries have established self-help cryonics groups whose mission is to cryopreserve human bodies or brains after legal death and ship them to cryonics organizations. The objective of this study was to report the first case of human brain cryopreservation in Argentina and complementary experiments in rats. After legal death, the body of a 78-year-old Caucasian woman was transported to a funeral home where her head was submitted to intracarotid perfusion with 5 L cold physiologic saline followed by the same volume of cold saline containing 13% dimethyl sulfoxide and 13% glycerol. The brain was removed, temporarily frozen at -80°C, and shipped to a U.S. cryostasis facility. Three groups of rats were intracardially perfused with fixative but not frozen (Reference group), vitrification solution VM1 (Control group), or the cryoprotection solution used in the patient (Experimental group). Control and Experimental brains were stored at -80°C and subsequently assessed by immunohistochemistry for the adult neuron marker (NeuN), the immature neuron marker doublecortin (DCX), the dopaminergic neuron marker tyrosine hydroxylase, and the presynaptic marker synaptophysin (SYN). The number of NeuN-positive neurons remained unchanged in the experimental brain cortex, whereas the number of immature DCX neurons in the hippocampus fell markedly in the cryoprotected brains. The results were highly variable for hypothalamic dopaminergic neurons. Confocal microscopy for SYN revealed that cryopreservation did not affect the synaptic network in the hippocampus. To our knowledge, this is the first report correlating a human cryoprotection procedure with results in complementary experiments in laboratory animals.

Objective: Considering brain death as legal death plays an important role in both provision of organ transplants and cessation of medical support. Another aspect of this issue is to decide who will have authorization for cessation of medical support. In this study, medical, legal and ethical aspects of the issue were dealt with data collected through a questionnaire. Material and Methods: Volunteering 279 nurses and 179 doctors working in intensive care units of research and education hospitals in Istanbul completed the questionnaire. Obtained data were statistically analyzed and available regulations, medical requirements and ethical values regarding brain death were examined based on results of the analyses. Results: Of all the participants, 40.9% of the nurses and 5.6% of the doctors agreed that diagnosis of brain death should allow cessation of medical support. Forty-three percent of the nurses and 55.9% of the doctors thought that patients whose brain death has occurred should be withdrawn from life support systems and devices so that other patients in need can benefit from them, with a significant difference (p

The case of Jahi McMath has captured the attention of the public, healthcare professionals, and ethicists. Jahi was declared brain dead in late 2013, but her family transferred her to New Jersey to continue organ support. A lengthy legal battle has been ongoing since then. Jahi’s family and two neurologists, Drs. Calixto Machado and Alan Shewmon, believe that she is not brain dead. Her family and Dr. Shewmon think that she is capable of following commands, thus making her minimally conscious. Review of case materials. Because brain death is an irreversible coma, one of three conclusions must be drawn: 1) Jahi was never dead; 2) Jahi met the criteria for brain death, but she isn't dead now; or 3) Jahi's movements are not purposeful responses, and she has been brain dead since 2013. The possibility that a person who was declared brain dead is now following commands threatens to erode the notion that brain death should be considered legal death. The discordant ideas that Jahi is brain dead and is following commands can only be reconciled if a formal evaluation for determination of death is repeated by reputable examiners.

Background Withdrawal of life support and organ procurement for transplantation are the main implications of a diagnosis of brain stem death (BSD). Various factors may impact this important decision-making process. The present study sought to investigate the knowledge and attitudes about BSD among university undergraduates as a “well-informed” subgroup of our local population. Methods A cross-sectional questionnaire survey was administered to a sample of nonmedical university undergraduate students in Hong Kong. Results The subjects' overall knowledge of BSD was unsatisfactory. Only 24% of subjects knew that BSD was the equivalent of legal death in Hong Kong. Among subjects who agreed to withdraw life support treatment from themselves upon the diagnosis of BSD, 30% and 24% refused to do so for their family members or a stranger, respectively. Subjects who agreed to withdraw life support showed significantly better knowledge about BSD than did those who did not agree. Concerns about doctors' inclination to diagnose BSD to save resources and extract organs for transplantation were not observed to negatively affect subjects' decisions about life support withdrawal. Conclusion The level of knowledge is an important factor affecting an individual's decision concerning withdrawal of life support therapy upon the diagnosis of BSD. Adequate explanation and counseling are important to facilitate family members in coping with this important end-of-life issue.

Very low temperatures create conditions that can preserve tissue for centuries, possibly including the neurological basis of the human mind. Through a process called vitrification, brain tissue can be cooled to cryogenic temperatures without ice formation. Damage associated with this process is theoretically reversible in the same sense that rejuvenation is theoretically possible by specific foreseeable technology. Injury to the brain due to stopped blood flow is now known to result from a complex series of processes that take much longer to run to completion than the 6 min limit of ordinary resuscitation technology. Reperfusion beyond the 6 min limit primarily damages blood vessels rather than brain tissue. Apoptosis of neurons takes many hours. This creates a window of opportunity between legal death and irretrievable loss of life for human and animal subjects for cryopreservation with possibility of future resuscitation. Under ideal conditions, the time interval between onset of clinical death and beginning of cryonics procedures can be reduced to less than 1 min, but much longer delays could also be compatible with ultimate survival. Although the evidence that cryonics may work is indirect, the application of indirect evidence is essential in many areas of science. If complex changes due to aging are reversible at some future date, then similarly complex changes due to stopped blood flow and cryopreservation may also be reversible, with life-saving results for anyone with medical needs that exceed current capabilities.

The most common prescription medications encountered and recorded in the normal course of a death investigation by a medical examiner's office in a moderate-sized jurisdiction in an urban city are tallied, based on data collected from 2233 deaths reported in 1998. Medication history was available for 775 of these deaths and is reviewed in this study. The 25 most common medications are each briefly discussed, particularly adverse effects and possible toxicity of concern in the investigation of death. Medications to treat cardiovascular disease are by far the most commonly encountered. The 10 most common medications regardless of category were furosemide, digoxin, nitroglycerin, potassium, lisinopril, warfarin, albuterol, nifedipine, codeine, and amlodipine.

Sudden death (SD) of children and adults ages 1 to 40 years has received increasing attention over the past decades. In this report, we provide an overview of this problem, consider several mass screening strategies to prevent these events, and critically appraise these strategies in light of the well known Wilson and Jungner criteria (Table 1).1 Finally, we present an alternative approach: optimal assessment of first-degree relatives of newly diagnosed patients with an inherited cardiac disease and young SD victims to identify those relatives at risk of sudden cardiac death (SCD). View this table: Table 1. Wilson and Jungner Criteria for Assessment of Screening ### Definitions SD or its synonyms are generally defined as natural, unexpected death within 1 hour of the onset of symptoms.2 Four temporal elements should be considered in the use of this definition, that is, prodromes, onset of the terminal event, cardiac arrest, and biological death. The 1-hour definition refers to the period between onset of the terminal event, that is, acute changes in cardiovascular status, and cardiac arrest. Nonspecific prodromal symptoms, for example, chest pain, palpitations, or dyspnea, can be present during the days or weeks before a cardiac arrest.3 The biological legal death can occur days or weeks after the cardiac arrest, as patients can survive with irreversible brain damage and life support. In addition, when death occurs unwitnessed within 24 hours of being seen alive and functioning normally, this is also termed SD.2 In this report, the 1-hour definition is applied unless otherwise indicated. Depending on the underlying cause, SD can be divided into SCD, defined as SD from a cardiac cause,2 and SD due to noncardiac causes, for example, intracranial hemorrhage, epilepsy, pulmonary embolism, or asthma.4,5⇓ This subdivision is clinically relevant because cardiac causes are inherited in a significant …

Understanding the legal definition of whole-brain death is imperative for hematologists and oncologists who deal with end-of-life patients on a regular basis. At present, only whole-brain death in which there is no function of the upper brain or brain stem is legally recognized as legal death. Those advocating expansion of the current definition of death to encompass patients with higher brain death and brain-absent anencephalic infants cite increasing the organ pool and decreasing unnecessary treatment and costs as benefits. Those advocating a more narrow definition of death typically fear being misdiagnosed or prefer the traditional cardiopulmonary definition for personal and religious reasons. As medical technology advances, offering new hope to both the critically injured patients who might be potential donors and to those patients in need of donated organs, the definition of death will continue to be a topic of passionate debate.

The brain death debate is now 30 years old. Ever since the Harvard Ad Hoc criteria for brain death were published in August 1968, and the proposal was first made that the clinical diagnosis of brain death constituted the legal death of a human being (brain death as death), the brain death controversy has continued.1 However, except for a few unresolved issues, there has been a surprising degree of consensus on the major medical and legal aspects of this subject. One reason for this consensus has been the numerous sets of clinical criteria published by medical, pediatric, neurologic, and neurosurgical organizations in the United States and other countries. Even though these criteria varied somewhat in the clinical features essential to the diagnosis of brain death, the positions of these medical societies strongly supported the view that brain death was a highly reliable diagnosis in most cases.2 In the 1970s, when lawmakers were first involved in enacting statutory legislation equating brain death with death, they were informed by physicians that brain death was a medical syndrome that could be …

This refreshingly candid, easy to read little book seeks to explain issues, ie, the psychologies, underlying ethnic difference and racial prejudice, dynamics that ameliorate or worsen the social impact of America's increasing racial diversity. Dr Ainslie teaches his valuable lessons by telling the story of Anson, Texas, and its social and legal struggle over whether the town should allow a high school prom with dancing. The controversy is presented as a "symptom" of an underlying conflict over the changes Anson endured from the legal death of segregation and resultant increase in the ethnic composition of the population from 12% to 35%. Using this social stage, the author tells stories of individuals and families, thereby delving into the individual and collective psyches of the participants—insiders and outsiders—in the right-to-dance conflict, thus crystalizing the psychodynamics of "otherness." The book is an interesting mixture of sociology and psychoanalysis, intermingling an ethnographic approach with

To the Editor. —In May 1995, the report of the American Medical Association's (AMA's) Council on Ethical and Judicial Affairs 1 permitting the use of anencephalic neonates as organ donors was published in JAMA . At the June 1995 Annual Meeting of the AMA's House of Delegates, the Council was asked to reconsider its ethical opinion. Per this request, the Council undertook review of additional submitted scientific evidence on the condition of anencephaly. In December 1995, the Council reported at the AMA Interim Meeting that it would suspend its opinion deeming use of anencephalic organs prior to legal death ethically permissible. This brings the ethical policy of the AMA back in line with the United Network for Organ Sharing's position on harvesting organs from infants with anencephaly 2 and supports adherence to the "dead donor rule" in public policy. 3 The Council believes its report published in JAMA contributed to an

The application of investigative ethics to religious objections to the autopsy is essential for harmony in achieving the mission of medical legal death investigation. In Florida, an ethical advisory committee composed of religious, ethics, legal, and medical leaders established a unified statement for the practice of discretionary judgment and liaison with clergy. Our approach to religious objections to the autopsy as well as illustrative cases will be discussed.

Analyzing the properties of the reconciliation vessel, new questions arised about the origin of this wondrous circuit, as well as its configuration through the philosophical and cosmological basis of traditional Chinese medicine. Scrutinizing its location within Fu Hsi's octogram and according to the Yellow Emperor's coincidences in Ling Shu and Su Wen quotations, a plausible explanation raised up from a detailed methodological work embodied in this paper. Author's experience in cardiopulmonary revivals over many years takes to ponder his prospect of this situation from various angles, arising the comparison between legal, real and energy deaths against the possibility of more widespread recovery after terminal diagnosis.

FOR many years one of the most intractable problems of the National Health Service (NHS) has been the long time that some patients may have to wait for hospital outpatient consultations and the fur...