How Harvard Defined Irreversible Coma
- PDF / 1,907,967 Bytes
- 6 Pages / 595.276 x 790.866 pts Page_size
- 79 Downloads / 254 Views
NEUROCRITICAL CARE THROUGH HISTORY
How Harvard Defined Irreversible Coma Eelco F. M. Wijdicks* © 2018 Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society
Abstract The Harvard criteria for the definition of irreversible coma or brain death were a product of a multidisciplinary committee chaired by anesthesiologist Beecher. The Harvard criteria included unreceptivity, unresponsiveness, no movements or breathing, no reflexes with further delineation of brainstem reflexes, and a flat electroencephalogram (repeated after 24 h with no change). The apnea test involved disconnection of the ventilator for 3 min. Hypothermia or any other central nervous system depressant had to be excluded. The Harvard criteria (and what followed) have been a bane for bioethicists from day one. This historical vignette explains, criticizes, and celebrates this landmark publication for its courage to tackle the topic. The Harvard criteria resulted in more studies and more criteria gradually complicating matters until the American Academy of Neurology in 1995 provided the necessary simplicity. Keywords: Brain death, Criteria, History, EEG Introduction With the world in turmoil, death knocked often at America’s door in 1968, arguably not the best time to introduce a new definition of death. However, the “Harvard criteria,” better known as the “report of the ad hoc committee of the Harvard Medical School to examine the definition of brain death,” appeared in the Journal of the American Medical Association in the same year—now 50 years ago [1]. The Harvard criteria started a conversation and controversy not only for introducing a new definition of death but also for using the terms “irreversible coma” and “brain death” interchangeably. Far more seriously, several bioethicists thought that a new definition of death, editorialized by a transplant surgeon and transplant nephrologist, represented a conflict of interest. Some went a step further, arguing that the criteria were a construct to make transplantation less controversial and more publicly and medically acceptable [2]. Now, rethinking the dynamics and central discourse leading to the document 50 years later, we may have a better understanding why responses were initially mixed.
*Correspondence: [email protected] Division of Critical Care Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
For this historical vignette, I re-reviewed my personal copies of the Beecher files. For more perspective, I also reviewed the first organ donations at Mayo Clinic and interviewed neurosurgeons and transplant surgeons practicing in this era.
Leading up to the criteria To put the Harvard criteria into context, we have to consider several major developments in the preceding decade. Neurologists and neurosurgeons from Paris and Lyon had applied clinical observations to diagnosed death and irreversibility (la mort du système nerveux and le coma dépassé). Mollaret and Goulon more pointedly proposed several neurologic tests for brain function loss and
Data Loading...
