Brain death is normally seen as crossing the last frontier of life, at least in a clinical setting but Project Lazarus: Tech Firms to Bring the Dead back to Life. Until a patient has gone through brain death, we believe that some vestige of their personality must still be in there. But injury to the CNS, especially axonal trauma, is usually irreversible. Once the brain is dead, there are no palatable options.
So, in a proof-of-concept experiment that’s equal parts touchingly earnest and slightly creepy, a couple of biotech companies called Bioquark will start the experimental project called Reanima while the second company called Humai just got approval from the U.S. Institutional Review Board.
The question is: Who is considered Brain dead?
Most clinicians will base their approach on published guidelines from professional organizations. For example, here is a guideline from the American Academy of Neurology:
In summary, the procedure for confirming someone brain dead Involves the following;
THE RAP FEES is a mnemonic which serve as a mental guide for determining brain death in adults. You can think of it as “theraphies” or as “the rap fees“.
T = Time of brain injury/cardiac arrest, time to ROSC (return of stable circulation) and time NOW. What’s a reasonable time frame? Not sure. Most require at least 24 hours post-ROSC if due to cardiac arrest. The longer the time of observation the more accurate the declaration.
H = History of events surrounding CPR and any info to help decide what caused arrest (e.g. known cardiac disease/arrhythmia). The physician should always check for a LIVING WILL/advance directive.
E = Exam or Neuro Exam to: (1) confirm coma and to (2) demonstrate absence of brainstem reflexes (midbrain, pons, and medulla).
R = Reversibility must be excluded, i.e. factors such as hypothermia, anesthetics or CNS depressants, significant metabolic disturbances, and hypotension should not be present.
A = Apnea test to confirm absence of spontaneous breathing. In the past, this is performed by physician/neurologist as an extension of the assessment of brainstem function; in the US it now usually performed by the respiratory technologist.
P = Practice guidelines, protocols, state regulations; e.g. 2 independent determinations by physicians (with no competing interests e.g. involvement with organ transplant) at least 24 hours apart. The requirements vary depending on state/country/institution
Four Ancillary Tests: FEES – additional cost but may help if clinical criteria is inconclusive, confounding factors are present, and period of observation is short (e.g. transplant candidate).
F = Flow studies to demonstrate absence of cerebral blood flow; e.g. HMPAO-SPECT, CTA, TCD, and conventional angiography. The physician must understand the limitations of these tests and how to interpret the results.
E = Electroencephalography (EEG) using the standard for ECI/ECS recording. The physician must understand the strengths and limitations of this test. The physician must not confuse artifacts for electrocerebral activity.
E = Evoked potentials, especially somatosensory evoked potentials (SSEP). The physician must understand the strengths and limitations of this test. SSEP is prone to artifacts especially in the ICU, so I require needle electrodes for recording on the scalp.
S = Something else which I can’t recall or which is still experimental and needs further validation or expert consensus.
Brain death is irreversible and characterized by total brain function loss. A body that has suffered brain death, however, can stay alive via life support.
Now, what BioQuark CEO Dr. Ira Pastor and his team seek to do is to employ stem cell and peptide injections, as well as techniques such as nerve stimulation, to prompt regions of the brain and the central nervous system to repair and regrow themselves the way some fish and amphibians can. In this phase, the company is partnering with stem cell treatment specialist Revita Life Sciences.
The viability of this project remains to be seen but If the researchers can convince the stem cells to differentiate properly, they might actually achieve the growth of real brain tissue, not just neurons. It isn’t clear whether they’re going to try to convince still-viable brain tissue to repair or regrow axons by applying lasers and peptides, or to implant stem cells in such tissue, or to start with stem cells in vitro and grow a matrix and then implant that. In any case, such an achievement would be pivotal, not least because we’ve never yet managed to do it.
Only time will tell how far this project Lazarus will fair
In any case, we will keep track of this project and keep you informed..
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