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Tuesday, June 7, 2016

The Argument over Brain Death Gets Hot! To Smother or not to Smother with the Apnea Test!

Apnea test helped to kill him.
A number of people commented on my post about Israel Stinson basically calling me an ignorant know-nothing who doesn't have a clue about the brain death diagnosis. Well, I'm not a doctor or scientist, but I've been present with three people as they were dying when they're hearts stopped, they stopped breathing, and became cold and white. I know what death looks like. More than that, I've lived long enough to see the disrespect for those who are "unwanted" or lack the "quality of life" someone else deems necessary for them to have value. So I wasn't too impressed with those commenting who claim to have the qualifications to know better than Dr. Paul Byrne and other physicians raising serious question about brain death criteria.

One of the issues raised on the post was the use of the apnea test which one man claimed was completely benign. Well, Dr. Byrne says not and so does Dr. John Shea, MD, FRCP who wrote Organ Donation: The Inconvenient Truth which includes this description of the apnea test:
The deadly apnea test  
Every set of criteria for “brain death” includes an apnea test, considered the most important step in the diagnosis of brain death. The ventilator is discontinued. “Apnea” is the absence of breathing. The only purpose of this test is to determine if the patient is unable to breathe on his or her own, in order to declare “brain death.” It aggravates the patient’s condition and is commonly done without the knowledge or consent of family members. The ventilator is turned off for up to 10 minutes, carbon dioxide increases in the blood and the blood pressure may drop, indicating that cardiac arrest has occurred. The test significantly impairs the possibility of recovery and can lead to the death of the patient through a heart attack or irreversible brain damage. Dr. Yoshio Watenabe, a cardiologist from Natoya, Japan, stated that if patients were not subjected to the apnea test, they could have a 60 per cent chance of recovery to normal life if treated with timely therapeutic hypothermia (cooling). Note the similarity to cardiac death, later described. (17
And here's more, this from a mom, Melissa Caulk, whose child, Jamie, was diagnosed as brain dead after a serious auto accident. They did an apnea test on Jamie which likely made it impossible for him to recover. They might as well have taken a baseball bat and hit him over the head with it:
Dr. Paul Byrne on the Apnea test, “carbon dioxide normally remains below 45 in us and when a patient is on a ventilator, the goal is to keep the carbon dioxide below 45. When doing an apnea test (the test for sleep apnea is not an apnea test), the respiration supporting ventilator is taken from the patient causing the carbon dioxide to increase to at least 60, and sometimes higher. When the carbon dioxide goes to these levels, swelling in the brain occurs or gets worse if it is already present. This is tantamount to suffocation.”

Vanderbilt started Jamie’s Apnea test at >64 and finished it at >115.
Jamie was starved of oxygen for 25 minutes, likely making recovery impossible.
I’ll leave you to determine what occurred.
Dr. Cicero Coimbra, is head of the Neurology and Neurosurgery Department at the Federal University of Sao Paulo, Brazil. He also has denounced the Apnea test as a diagnostic tool. The test, he said, which cuts off oxygen to the brain, will bring about severe, irreversible brain damage in patients who, with proper care, would otherwise have had a good chance of survival.

“Diagnostic protocols for brain death actually induce death in patients who could recover to normal life by receiving timely and scientifically based therapies,” he wrote.
Dr. Coimbra also has stated, in his research paper Apnea Test A Bedside Lethal ‘Disaster in the Operating Room, “while most physician advocates may publicly comment on “the possibility of damage by the apneic insult to transplantable organs,” they are unwilling to publish information on “the ethical implications of worsening the clinical and neurological conditions of the potential donor or even causing his (or her) death.”
He argued: A large number of brain-injured patients, even in deep coma, can recover to lead a normal daily life; their nervous tissue may be only silent, not irreversibly damaged, as a consequence of a partial reduction of the blood supply to the brain. (This phenomenon, called “ischemic penumbra,” was not known when the first neurological criteria for brain death were established 37 years ago.)
However, the apnea test (considered the most important step for the diagnosis of “brain death” or brain-stem death) may induce irreversible intra-cranial circulatory collapse or even cardiac arrest, thereby preventing neurological recovery. Dr. Cicero Galli Coimbra, “The Apnea Test — A Bedside Lethal ‘Disaster’ to Avoid a Legal ‘Disaster’ in the Operating Room,” Finis Vitae, pages. 135,335,313-319 and 355.
In plain, simple, language Dr. Coimbra used this word picture. 
If you show up in the emergency room with a possible heart attack, the doctors don’t subject you to a stress test. You are cared for in every way to prevent any further stress to your heart.
When your brain is injured and you agree or are subjected to an Apnea test you are putting further stress on a severely injured organ…your brain.

No doubt the nay sayers who are enthusiastic about offing "brain dead" patients and giving their organs to others will pooh-pooh all this. The apnea test is the "gold standard." What do Dr. Shea and Dr. Watenabe and Dr. Coimbra know about it? Like Dr. Byrne, they are just fanatics who want to cart dead bodies around their countries claiming they are still alive.

Actually, on second thought, calling the apnea test the "gold" standard is accurate. It decreases the probability of the patient improving, increases the likelihood of cardiac arrest, so the hospital can let the heart stop for a few minutes, restore the ventilator and proceed to the "organ procurement center" where they can gain a rich "gold" harvest from selling the patient's organs. Oh, but doctors would never do that, right?

I won't question the motives of people on my blog claiming there is no problem with the brain death designation. But I suspect I've done every bit as much "homework" as they have, and I will fight for the lives of those who can't fight for themselves until I myself am cold, white, and stiff, i.e., REALLY DEAD!


Ken Brown said...

when a normal person's CO2 levels get too high, the body is stimulated to breathe. the apnea test looks for that stimulation. the patient is stabilized as much as possible before the test and ANY irregularity results in the test being aborted.

would it surprise you to know that in a heart attack patient, CPR is periodically halted to look for a heart rhythm? this halt is no more stopping the patient's heart than the apnea test is smothering the patient.

Mary Ann Kreitzer said...

That's not what happened with Jamie.

Ken Brown said...

I was unable to find any objective documentation on Jamie.