RESEARCH keeps pushing the envelope and forging new frontiers in science. One of the latest push is to discover whether brain death is reversible.

Brain death is defined as the total and irreversible loss of all brain function, with the ceasing of respiration. Doctors, health care workers, members of the clergy, and laypersons around the world have generally come to accept that a person is dead if his or her brain is dead.

However, the use of mechanical ventilators and other advanced critical care services have been able to artificially maintain some of the vital functions of the body, sometimes for a very long period of time after the brain has ceased to function.

This mechanical support has allowed time for certain organs of the body to be retrieved for possible transplantation to other people in need of the particular organs (for example kidney, heart, liver). It has also now led researchers from India, working with others from the United States of America (USA), to conduct a clinical trial (a form of research used to ‘prove’ ideas) to test a research proposal to reverse brain death.

Approval for the research was recently granted by the authority responsible for clinical trials in the USA.

THE RESEARCH PROJECT

The Reanima project, as it is called, received approval to experiment on 20 research subjects that have been diagnosed as being brain dead at a hospital around 120 miles east of New Delhi in India, and will be conducted by an Indian company working with a US biotech company.

The researchers believe that this could be a breakthrough biotechnology that provides another step in the path towards the eventual reversal of brain death within our lifetime.

They see this as distinctly possible since medical technology currently facilitates brain dead patients to circulate blood, digest food, excrete waste, balance hormones, grow and sexually mature, and even heal wounds, spike a fever, and gestate and deliver a baby.

The researchers have studied the regenerative properties of amphibians and other animals, and believe that it is possible to regenerate brain tissue in humans using the disciplines of regenerative biology, cognitive neuroscience and clinical resuscitation.

Consequently, in the experiment, protein peptides will be injected into the spinal cord of the research subjects daily via a pump, with regenerative stem cells being given every other week over a six-week period. The ultimate aim is the full recovery or regeneration of brain tissue in such patients.

However, critics have commented that whilst research in recent years have revealed that human brain and nervous tissue may not be as fixed and irreparable as was previously assumed, the idea that the death of the brain could be easily reversed appears far-fetched, given our current abilities and understanding of neuroscience.

They believe that whilst saving individual parts of the brain might be helpful, the state of the art is currently a long way off from resurrecting a whole working brain into a functional, undamaged state.

OUR CHALLENGE

As laypersons, how we perceive scientists’ approach on this new frontier will be coloured by our particular view of the world. Are we ‘neutral’ in our approach to such matters, and do not ascribe ‘value judgements’ to advances in technologies and research? Do we believe in the ‘wisdom of nature’ — the view that ‘nature’ has the best ways of doing things, and so man should not tamper with such matters?

Is our world view rooted in the concept of ‘God and religion’, with the belief that certain technological innovations go against the will of God? Are our thoughts and beliefs driven by the notion of ‘natural purpose’, whereby all living things have essential functions that are linked to what is ‘good’ for them and which science should not wish to change? Or is our reaction simply one of disgust, revulsion, or fear that is prompted by novel technologies and research experimentation?

We should be aware that in pluralistic societies like ours, there is no one reaction, approach, or monolithic view on such issues. Hence, while many persons are focused on the possible outcomes of the research when it comes to completion in India, the reactions to the outcomes will vary depending on each person’s view of the world and perception of our purpose here in it.

Certainly, whether this research regenerates brain cells or not, it demonstrates that some people are forging new frontiers that may not be embracing teleological concepts or theological dictates that certain efforts are best left to God.

As man’s efforts in such endeavours reflect the plurality of values that exist across our world and the views of our place within this brave new world, we must prepare our minds to address such matters, and join the debate that these matters will naturally engender. Hopefully we will come to a consensus with which we all can be comfortable.

Let us begin these discussions now.

Derrick Aarons MD, PhD is a consultant bioethicist/family physician, a specialist in ethical issues in medicine, the life sciences and research, and is the Ethicist at the Caribbean Public Health Agency – CARPHA. (The views expressed here are not written on behalf of CARPHA)