Movements in Brain Death

Abstract

Spontaneous movements and reflexes in brain death are discussed. It is well known that can occur and these movements arise from spinal cord neurons. However, they do not preclude the diagnosis of brain death and are considered spinal reflexes—plantar responses, muscle reflexes by stretching, and jerking movements of the fingers. Abdominal contraction is present in 60 % of donors when the peritoneum is incised. Reflex movements originate from the spinal cord starting from the C1 metamer, and they involve a variable number of inferior metamers. A pathophysiological explanation could be the occurence of superior control loss of phylogenetically more recent structures over the inferior, spinal cord, more archaic. When the subject is treated by ventilatory support and pharmacological therapy, spinal cord neurons are oxygenated by the blood supply. In this way, spinal cord shock is resolved, and neuronal function recovery can trigger reflex movements. Anesthesiologic management in organ donors is discussed. Newspaper headlines: for those who work every day in transplant surgery, it is not rare to read sensational headlines where the donor just before the “execution” suddendly recovered. It should be clear that there is a complete discrepancy between a coma and a vegetative state, and the headlines confusing the two situations are significantly hindering organ donation.