Who’s Dead? What’s Dead?

Who’s Dead? What’s Dead?

By

Leonard Zwelling

The first is a question asked by Olympia Dukakis as Rose Castorini of Vincent Gardenia (her husband Cosmo) in the great film Moonstruck when he wakes her up from a deep sleep.

The second question is one most doctors think they can answer and have been trained to do so. When has the duration of cardiac compressions and artificial ventilation reached the point when there’s no coming back for the arrested patient? We thought we knew. Maybe not.

In this piece from The New York Times on August 4, Gina Kolata describes brand new research on dead pigs. Or at least they seemed dead.

“The pigs had been lying dead for an hour—no blood was circulating in their bodies, their hearts were still, their brain waves flat.”

Then the Yale neuroscientists infused the animals with OrganEx, a solution they devised that contains “nutrients, anti-inflammatory medicines, drugs to prevent cell death, nerve blockers…and an artificial hemoglobin mixed with each animal’s own blood.” Upon infusion the one-hour dead pigs’ hearts began to beat and their organs were revived. Pigs treated with extra-corporeal membrane oxygenation without OrganEx stayed dead. They had to get OrganEx to return from the dead.

This work will undoubtedly lead to the use of pig organs as donor tissue for humans and perhaps even aid recovery from heart attack or strokes suffered by people. Regardless, this work alters the definition of dead.

The ethical implications of this work are staggering.  As one of the commentators in the Nature issue in which the report was published noted, “these pigs were dead.” But their organs were not and perhaps, had they been conscious, maybe their brains were not dead either.

There’s obviously a long way to go before this technology can be used to create unlimited supplies of human donor organs or more importantly used to actually really do a Lazarus and bring someone back from the state we used to consider dead.

Perhaps most crucial will be the assessment of whether or not this “magic” solution can keep a human brain alive after what we used to consider brain death and what will that mean for ICU doctors having to determine who’s dead and what dead even means?

Finally, you have to admit that you would love to talk to someone who has died and come back. What happened on the trip? What were the perceptions of death, if any?

My generation of physicians will not have to deal with this. What we were taught about dead is still probably clinically applicable today. But the young physicians of today may well have to reconsider what dead is and when to declare someone dead. Will the very rich corner the market on OrganEx? Who gets to try it?

The ethical downstream effects of these pig experiments are tremendous and will challenge Institutional Review Boards as well as hospital ethics committees for generations to come.

I used to think I knew dead. I was wrong. They say even a blind pig can root up an acorn every once in a while. But a dead pig may roar back to life. What about a dead human? Who’s dead? What’s dead? Good questions.