A Miracle or a Mistake?
Natalie Morales: What did the doctors tell you at that point? Natalie Morales: Were the doctors giving you any sense of hope?
Zack Dunlap was apparently killed in an auto accident and his organs were going to be procured, when he "came back." From the story:
The Dunlaps agreed to organ donation. But they also turned to God and prayed for a miracle. That's when Zack's condition appeared to change. A nurse scraped his foot and he reacted. From the story:
Pam Dunlap: She just said it wasn't good.
Doug Dunlap: She said brain matter was coming from Zack’s ear.
Pam Dunlap: All I can remember is just being down on my knees saying, you know, "No. No, God, no. This isn't going to happen." Zack was Medivac’ed to a hospital 50 miles away, in Wichita Falls, Texas--one equipped to deal with traumatic brain injury...
Doug Dunlap: They were already saying he was brain-dead. (Looking at brain scan)
Natalie Morales: So, when you see this, I mean, he was in a permanent vegetative state?
Dr. Mercer: No, he was dead. He meets the legal, medical requirements for declaring a patient brain dead. Tough as it was, the Dunlaps decided against keeping Zack on long-term artificial life support.Natalie Morales: As a trauma surgeon and seeing this 21-year-old coming back to life, do you have any sort of medical explanation that you know of?
I understand why Pam Dunlap would embrace the miracle, but we should be more skeptical. This much is sure: Either it was a miracle--which raises interesting issues in itself--or Zack wasn't really and truly dead.
Dr. Mercer: I don't.
Natalie Morales: Were any mistakes made, or was the process rushed along in any way to declare him brain dead because the family made you aware that he was an organ donor?
Dr. Mercer: No. We didn't rush anything along. We certainly don't do that.
Pam Dunlap: We saw the test. We saw it. They followed every procedure. He was gone.
Natalie Morales: So there is no blame?
Pam Dunlap: There's no blame in a miracle. And there never will be for us.
Which it is matters a whole lot. Thus, Zack's "miracle" should not be left as a wonderful and heart warming television story. It needs a deep and meticulous investigation to ensure the public that a living man was not prematurely declared dead. Or, if he was legitimately declared dead, we need to be assured that the criteria used were appropriate. If they were appropriate, we also need to know whether they need to be reviewed. For example, was enough time allowed to pass from initial declaration of brain death until a second confirming test? Was there a second test?
In any event, leaving it as a "miracle"--even if it turns out to be true--just won't do. Answers based on the records and the scientific knowledge of this matter are clearly required to make sure that if God was not involved, that what almost happened to Zack doesn't happen again.
Labels: Brain Death
posted by Wesley J. Smith @ 11:36 AM
17 Comments
17 Comments:
I'm entirely skeptical. The stories I'm getting when I google it quote one of the doctors (via a relative of the patient) as having said, "There must have been faulty equipment on the first test." What equipment would that be? What about the second test?
(Sorry if this is duplicated. The first comment didn't seem to post.)
If this is true, it's the only case I know of in which a brain-dead patient "came back."
Regarding the question of the diagnosis, since there is no uniform test for brain death, there is also no requirement for a second test.
Moreover, advocates of brain death beg the question when they dismiss any counter-example as a misdiagnosis. I agree, there is much to be skeptical about on the issue of brain death.
But the reference to "the first test" makes it sound like in this case there _was_ a second test. I assume we're talking about EEG's? But we're also supposed to be testing for brain _stem_ activity, right?
I'd love to know what-all they tried. After all, the doctor in the interview says they followed all the protocols and such. What, exactly? What sort of reflex tests did they do? Did they try taking him off the ventilator? (They'd better have.) And so forth. But we'll probably never know, as the family believes it was a true miracle.
I don't know much about brain death, but this comment by Doug Dunlap is curious to me, "She said brain matter was coming from Zack's ear."
I am not entirely skeptical.
Yes, all sorts of questions need to be asked. It's frustrating to know what a real investigation would be like, and to suspect that one is being done, but you won't really see it because the reporters don't know how to report it.
But I believe God can and does do this kind of thing when he chooses to.
A non-religious person might say, "It just wasn't Zack's time."
A student in my Criminal Law class said that his best friend was diagnosed as brain dead by a neurologist at a reputable hospital, with all the confirmations done. She regained consciousness later that day and spoke to her family. She died four days later.
According to this student, the neurologist claimed that there was no scientific explanation for what happened and that he had never heard of such a thing happening before.
Unfortunately here seems little chance of gathering such anecdotes for a scientific review. I also wonder if there is any desire to know if there are more of these cases, as it would be quite dispruptive to re-think the brain death criteria at this point. It does make you wonder though.
Oh, I'm not skeptical - the boy was probably "brain dead" as in his brain was shut down and non-functional.
But obviously his soul wasn't ready to depart his body, meaning that yes, the order to grab his organs for donation was probably rushed. We can revive dead people up to thirty minutes after they die in a lot of cases, if the soul's not ready to go, or if God has other plans for said dead person.
Wesley's right - it's likely the whole donation bit was rushed. It doesn't sit well with me at all - and I know that organs have to be procured quickly, but so much so that a person gets hacked up before he knows whether he should be coming or going? And probably if he wasn't ready to die yet, his body would have started with subtle signals that the doctors could have picked up on. I don't know. I don't doubt it was a miracle, but I don't like how hurried the situation was.
No wonder folks are pushing for "presumed consent" for organ donation...these various stories about folks who shouldn't be carved up being carved up (either via induced or presumed death) is enough to make me think twice about that "organ donor" note on MY license.
(and that's as someone who donates every time she's eligible)
What are they doing using a PET to diagnose brain death? It's not even sufficient as an ancillary test.
Yoiks. Don't go down in Texas!
It remains to be seen whether this is really a "miracle" or whether enough of the poor guy's brain oozed out of his ears to make him into a vegetable. There's more to "being alive" than breathing.
HW: Again, as in the other comment that you lfet, the "V" word is unacceptable here.
Zack has recovered and is leading an active life.
Serious George, where did you get the info. that it was a PET they did? I've been googling around trying to find out what tests they did and couldn't find details.
Lydia,
In some of the available accounts, Zack's father reports being shown the PET scan (which apparently was repeated) showing no perfusion to the brain. One report mentions that the doctors involved presumed the test If that's the case, then something's awry, since PET isn't accepted as a quantitative test for this purpose. It's always possible that dad misnamed the study, or this was misreported, now a few months out from the intial event. If so, and what they did was perfusion scintigraphy (the appropriate test) then this is another matter altogether.
Thanks, George. That's useful.
I notice how the one nurse tried to brush off the reflex from the knife blade ont he sole of the foot. But I had read somewhere that one test for brain death is to show that there are no reflexes, such as reflexes to cold water poured into an ear. But now it's looking like they are saying, "It's just a reflex" even when the person is supposed to be truly brain dead. So is a truly brain dead body supposed to have reflex responses, or not? Some but not others, or what?
The spinal cord can handle some simple reflexes on its own. Withdrawing a foot is simple; pulling your arm away and across the chest (as he's reported to have done) is more complex and should raise eyebrows. The cold water (caloric reflex) is specifically to test for a brainstem reflex -- turning of the eyes toward the ear that's irrigated [don't try this at home; you'll get violently dizzy and vomit]. This is a pretty good reference.
"Dunlap said one thing he does remember is hearing the doctors pronounce him dead."
""I'm glad I couldn't get up and do what I wanted to do," he said.
Asked if he would have wanted to get up and shake them and say he's alive, Dunlap responded: "Probably would have been a broken window that went out."
His father, Doug, said he saw the results of the brain scan.
"There was no activity at all, no blood flow at all."
From
http://www.cnn.com/2008/US/03/24/NotDead.ap/index.html?eref=rss_topstories
Simply put: He wasn't dead. He HEARD them DECLARE he was dead, and he remembers that. He just couldn't do anything about it.
We do not know enough about death/dying/consciousness. How about we err on the side of life? I for one do not want to be alive and conscious while my organs are being harvested- I doubt anyone would.
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