The results of 20 years of research on brain death will be released to the public, the Chinese Ministry of Health reported in early April.
A special ministry team has drafted the criteria for brain death in Criteria for the Diagnosis of Brain Death in Adults (Revised Edition) and Technical Specifications for the Diagnosis of Brain Death in Adults (Revised Edition), which create standards for clinical diagnosis, confirming tests and pronouncements for time of brain death.
Beijing-based Xuanwu Hospital affiliated to the Capital Medical University researchers spent five years investigating the feasibility and reliability of brain death diagnosis, according to sources at the Ministry of Health.
The concept of brain death was introduced in China in 1986. In 2003, a task force of the Ministry of Health published drafts of the two documents in medical journals, which attracted a great deal of attention.
Huang Jiefu, Vice Minister of Health, said diagnostic criteria for brain death had become clear in the 1980s but China put no laws on the books providing guidelines. Today, with the development of the country's economy and concerns about the affliction, China has taken up the subject at international organizations like the World Health Organization. As a result, it has become necessary to make laws about brain death in China, said Huang.
Brain death has been recognized by 80 countries including China, and 14 countries have adopted legislation creating standards for recognizing it, said Huang
Because of traditions and religious beliefs, this thorough study was one of the few ways for the Chinese to accept a new conception of death. Huang said that the two events of apnea and cardiac arrest and brain death could exist at the same time to ease Chinese people's worries about the new concept of death-brain death.
Most people, he said, will stop breathing and their hearts will stop when they die but around 5 percent will lose brain function first and their cardiopulomary systems will continue working.
Huang said brain death is different from a patient in a chronic vegetative state. Those in vegetative states retain some lower brain function like spontaneous respiration and some can even recover, but brain death means the irreversible loss of function of the whole brain including the brainstem.
"Making laws for brain death is important not only to save medical resources but also to make the Chinese rediscover the conception of death," said Huang.
A brain dead patient will last on average seven days before the other systems shut down. During this time, medical staff must do a great deal of work to keep the patient's body alive.
Huang also said that brain death laws might be helpful to promote the development of organ transplant donor programs.
Today, China's organ harvesting programs, such as heart, liver and kidney transplantation, have made progress but because of a void in brain death laws, a steady source of organs still cannot be guaranteed and the scientific research achievements on Chinese organ transplantation cannot be admitted by the international circles due to doubts about source of organs, according to Huang.
On March 21, 2007, the State Council of China issued the Regulation on Human Organ Transplantation, breaking barriers to regulating laws on brain death. According to sources from the Ministry of Health, at least 63 brain-dead people have donated 283 organs and saved 270 lives so far.
However, the most important task is to encourage more citizens to accept the concept of brain death, said Tan Jianming, a professor at Shanghai No. 1 People's Hospital and Director of Shanghai Organ Transplantation Research Center. He said the Chinese need at least 10 years to understand and accept the concept of brain death and organ transplantation. The laws setting guidelines for brain death are just the first step.
On April 10, 2007, Wuhan Tongji Hospital in central China's Hubei Province declared the death of Mao Jinsheng, the country's first case of brain death according to the Criteria for the Diagnosis of Brain Death in Adults.
According to information from the hospital and with the approval of Mao's family, doctors gave three times of brain death tests, abiding by both international and Ministry of Health criteria, and confirmed Mao's death finally.
Some experts thought the promulgation of criteria for brain death would present challenges to China's present laws. Critics say that before brain death is allowed to become law, doctors who withhold life support from brain dead patients could expose themselves to charges of murder or negligence. Besides, after the promulgation of the criteria, some other laws, such as the one regarding inheritance should make relevant changes to resolve disputes aroused from brain death.
Brain Death, Concept and Criteria
The concept of brain death originated in France. In 1959, the French scholars P. Mollaret and M. Goulon proposed the concept of "coma depasse" or "brain death" for the first time and reported 23 cases with such symptoms.
The first guidelines (the Harvard criteria) for diagnosing brain death was established in 1968, defining brain death using four criteria: irreversible coma depasse, spontaneous apnea, absence of brainstem reflexes and loss of brain waves. The prerequisites are core temperature with no less than 32.2 degrees Celsius, exclusion of complicating medical conditions that may confound clinical assessment (no severe electrolyte, acid-base, or endocrine disturbance) and no drug intoxication or poisoning. Since then, the Harvard criteria has been accepted widely by many countries.
(Source: Health News)