12 January 2000

Are they really dead?

by Kate Melville

In what must surely be the basis for a new horror movies researchers have just released a study relating to the spontaneous movements (such as jerking of fingers or bending of toes) of brain dead people. These movements occur in 39 percent of brain-dead patients and can be disturbing to family members and health care professionals and even cause them to question the brain-death diagnosis. All this macabre information is included in a study published in the journal of the American Academy of Neurology.

"We found that these movements are more common than has been reported or believed," said Dr. Jose Bueri, of J. M. Ramos Mejia Hospital in Buenos Aires, Argentina. "People need to know that these movements are spinal reflexes that do not involve any brain activity."

Dr. Bueri's study examined all brain dead patients at the hospital during an 18-month period. Of the 38 patients, 15 had these motor movements. In all cases, the movements were seen in during first 24 hours after the diagnosis of brain death diagnosis, and no movements were seen after 72 hours.

"If the lack of understanding of these movements leads to a delay in the brain death diagnosis or questions about the diagnosis afterwards, there can be important practical and legal implications, especially for organ procurement for transplantation," Bueri said. "Family members and others need to understand that these movements originate in the spinal cord, not in the brain, and their presence does not mean that there is brain activity."

One of the most startling movements for family members and health care professionals is called the "Lazarus sign." It is a sequence of movements lasting for a few seconds that can occur in some brain dead patients, either spontaneously or right after the ventilator is disconnected. According to Bueri, "It starts with stretching of the arms, followed by crossing or touching of the arms on the chest, and finally falling of the arms alongside the torso. It is also a spinal reflex, but it can be disturbing to family members and others who see this."

Another article in the same edition of Neurology described movements in two brain dead Spanish patients (a 30-year-old woman and an 11-month-old baby). Both extended their arms, flexed their wrists and curled up their fingers each time a mechanical ventilator inflated their lungs. Movement ceased when they were disconnected from the ventilator.

So while it is important that the public and health care professionals be aware of this possibility, the Science A Go Go editorial staff would be prepared to wager that such this would be completely forgotten when any of our readers saw such a macabre event.