Steven Thorpe, then 17, suffered horrific injuries in a multiple car crash, leaving him in a medically-induced coma and another man dead.
Doctors told his family he would never recover and asked them to consider donating his organs before his life-support machine was turned off.
Instead, Steven’s father enlisted the help of private GP Julia Piper to check his son again as doctors at University Hospital in Coventry, West Midlands, agreed to let a neurologist re-examine him.
Remarkably, he detected faint brain waves indicating Steven had a slim chance of recovery and medics decided to attempt to bring him out of his coma.
Just five weeks later, he was discharged from hospital having made a near-full recovery.
והנה
מקור נוסף שמתייחס למקרה אחר. גם אם נניח כדבריהם שהבדיקות לא היו מדויקות, מי ערב שבכל שאר המקרים הן כן היו מדויקות. המקור נשמע רציני, אך מקריאתו עלו בקרבי כמה תהיות אציין אחת מהן. הוא כותב שבמשך 36 השעות הראשונות ישנה נפיחות שאינה מאפשרת את קביעת המוות המוחי בוודאות משום שיתכן שפעילות המוח מנוטרלת בגלל הנפיחות ולא בגלל מוות. לכן הוא מציין שהוא נמנע מקביעת מוות מוחי באדם צעיר בטרם עברו 36 שעות אלו.
Let’s take a look at this case. I only have the details provided by the media (I have called Dr. Mercer but have not gotten through yet), so I can comment on some things and not others. The primary problem I have with this case is that the determination of brain death was made 36 hours following a severe head trauma. Brain trauma causes edema or tissue swelling, just like would happen to any body part after injury. This brain edema increases over about 72 hours and then starts to resolve. Because the skull is a closed space, this swelling squeezes the brain causing temporary dysfunction. It can also cause permanent damage in some cases. But during this period any clinical assessment of the patient in order to determine the amount of permanent brain damage is problematic because you can’t know how much is due to reversible swelling. Patients may look terrible, but then in a few days when the swelling goes down make a remarkable recovery. This is more likely in younger patients because young brains are plump and therefore they swell more and there is less room in the skull to begin with.
In fact when I consult on such cases I also couch my opinions in terms of – we cannot make any definitive statements during this period, we have to wait until the swelling resolves. You can infer how much damage is likely based upon laboratory tests, like a CT scan or MRI which can show the edema and may also show if there is large amounts of blood in the brain or other anatomically visible abnormalities.
In short (with the caveat that I do not have all the facts from a first hand source) I have a problem in general with declaring a
young person brain dead 36 hours after a head trauma. Unless there were solid laboratory evidence of irreversible brain death I would always wait at least until the swelling resolves to make this diagnosis.
בשל כך אני תוהה א' האם שיקולים אלו מקבלים ביטוי בנהלים בארץ ובארה"ב. ב' מה לגבי אדם מבוגר. האם לו מגיע למות בטרם עיתו.
ראשי
צ'אט
17-06-2013, 10:28
(קרדיט למרשי)
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