1/4. Confounding factors in diagnosing brain death: a case report.BACKGROUND: brain death is strictly defined medically and legally. This diagnosis depends on three cardinal neurological features: coma, absent brainstem reflexes, and apnea. The diagnosis can only be made, however, in the absence of intoxication, hypothermia, or certain medical illnesses. CASE PRESENTATION: A patient with severe hypoxic-ischemic brain injury met the three cardinal neurological features of brain death but concurrent profound hypothyroidism precluded the diagnosis. Our clinical and ethical decisions were further challenged by another facet of this complex case. Although her brain damage indicated a hopeless prognosis, we could not discontinue care based on futility because the only known surrogate was mentally retarded and unable to participate in medical planning. CONCLUSION: The presence of certain medical conditions prohibits a diagnosis of brain death, which is a medicolegal diagnosis of death, not a prediction or forecast of future outcome. While prognostication is important in deciding to withdraw care, it is not a component in diagnosing brain death.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
2/4. Ecstasy-induced brain death and acute hepatocellular failure: multiorgan donor and liver transplantation.BACKGROUND: Ecstasy is a neurotoxic and hepatotoxic drug. brain edema and fulminant hepatic failure are two of the most serious complications associated with the consumption of ecstasy. Acute ecstasy intoxication can transform a patient into an organ donor or a hepatic graft recipient. MATERIALS AND methods: In the last 5 years in our centers, we have had two multiorgan donors who died from ecstasy-induced brain edema and three patients who required urgent orthotopic liver transplantation for treatment of severe acute hepatocellular failure induced by this drug. We performed eight transplantations using the organs of these two brain-dead donors: one heart, one bipulmonary, three kidneys, one kidney-pancreas, and two livers. RESULTS: Toxicity caused by ecstasy was not observed in any of the eight patients who underwent transplantation. The clinical state and the graft function of the heart, two liver, renopancreatic, and three kidney recipients were normal for a follow-up period that ranged between 7 months and 4.5 years. The lung recipient died from multiorgan failure secondary to bilateral pneumonia 5 days after the transplantation, and one of the kidney transplant patients died as a result of intestinal lymphoma 6 months after transplantation. The three liver transplantations in the three patients with ecstasy-induced fulminant hepatic failure were performed successfully using orthotopic transplantation. These three recipients are asymptomatic and have normal-functioning hepatic grafts after follow-up of 3.5 years, 15 months, and 11 months, respectively. CONCLUSIONS: The thoracic and abdominal organs of people dying from ecstasy intoxication can be viable for transplantation. The short- and medium-term survival of the graft and of the recipient have been similar to that of other organ donors. Urgent liver transplantation is an effective therapeutic option in patients with ecstasy-induced acute hepatocellular failure.- - - - - - - - - - ranking = 2keywords = intoxication (Clic here for more details about this article) |
3/4. Successful transplantation of organs from a donor who died from acute cocaine intoxication.One to two percent of the general population of western countries are regular consumers of cocaine, 10% being sporadic consumers. This proportion increases considerably in the population age groups which are most frequently organ donors. cocaine may directly cause brain death, or be present in those with brain death who died from other causes, especially head trauma. We present a 30-yr-old female donor, a regular consumer of inhaled cocaine, who died of brain anoxia after cocaine inhalation. Twenty-five hours after cocaine inhalation, the liver and kidneys were removed for transplantation. The liver was transplanted to a patient with acute hepatocellular failure caused by isoniazids, and the kidneys to two recipients with renal polycystosis. Toxicity attributable to the cocaine was not observed in any of the three recipients. All three grafts presented immediate function, and the clinical evolution of all three recipients and the function of all three grafts were excellent during the 5 yr of follow-up. The serum creatinines of the two kidney recipients 5 yr from transplantation were 76 and 72 micro mol/L, respectively.- - - - - - - - - - ranking = 4keywords = intoxication (Clic here for more details about this article) |
4/4. brain death and persistent vegetative states.patients who suffer severe brain damage may be brain dead, even though their cardiorespiratory function is supported by mechanical ventilation. According to criteria established in the United Kingdom and the united states, if these patients meet the preconditions of apneic coma that is attributable to diagnosed irreversible cause, and the presence of drug intoxication, hypothermia, or metabolic coma is excluded, then documentation of absent brainstem reflexes and apnea despite a PaCO2 of 50 mm Hg or greater will confirm the presence of brain death. If the brain is dead, the patient is dead, regardless of the state of his circulation, and he should be declared dead and removed from the ventilator. If the patient has lost higher cortical function but brainstem function is preserved, he may be in the persistent vegetative state and live for years with apparent sleep-wake cycles but no awareness of any external or internal stimuli. As the prognosis for recovery from the persistent vegetative state is absent, there is no ethical responsibility to continue treatment other than to provide basic nursing care to maintain the dignity of the patient.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |