Is death the end or can we win the battle against mortality?

GUEST ARTICLE

Death is inevitable. There are many definitions and meanings to it. Some people believe death is the end of life, whilst others believe that death is not the end and is just the beginning of another life that we do not fully understand.  The Oxford definition of death is ‘the action or fact of dying or being killed, the end of the life of a person or an organism.’ The medical definition of death is ‘An individual who has sustained either irreversible termination of circulatory and respiratory functions.’ But how do doctors classify death?

Originally, death had been defined as when the heart stops beating and there is no blood circulating the body. This causes a person to immediately stop breathing, their brain shut down and become non-functional. However, researchers have shown and believe that if they can restart the heart after a person has gone through the first stage of death, then they can bring them back without any brain damage. However, death is not that sudden because when a person dies, their cells start to undergo a process of dying as well, and this can take hours. So, can doctors potentially bring back someone once they have died? With an increase in medical innovations and medical science, the line between living and death is becoming gradually more unclear. Even though this is a complicated process, it may be possible.

It is becoming more difficult to distinguish between those living without the reliance on technology and those that are fully independent, especially with machines such as a mechanical ventilator.  Mechanical ventilation is a life-saving therapy that has increased the development of modern intensive care significantly. The youth, especially those in developing countries, are vulnerable to acute diseases and respiratory failure, and therefore large numbers of patients unfortunately die due to a lack of resource and funding. It additionally helps in tackling respiratory problems in patients for a short period due to them suffering from an infectious disease, trauma and peripartum maternal or neonatal complications etc. Also, mechanical ventilation can help prolong their lives too, giving someone anywhere from a few extra minutes to years of their life that would have otherwise been lost. When the use of ventilators in modern medicine first began, it helped save many lives of patients with polio who were suffering and dying from respiratory failure, thus reducing the mortality rate from 87% to 25% (Journal of Global Health).

Furthermore, mechanical ventilation is a ‘life-sustaining treatment’ which, however, does have its risks which can include patients who are on the ventilator being more likely to get pneumonia. Even though mechanical ventilation can help prolong someone’s life, by assisting them in breathing, it does not mean the patient would be able to breathe unaided. There have been countless cases where the illness that led to the need of a ventilator not improving despite the intensive treatment. A recent example includes the case of Charlie Gard. Charlie Gard was an infant boy from London, United Kingdom, born with mitochondrial DNA depletion syndrome (MDDS), a rare genetic disorder that causes progressive brain damage and muscle failure. His parents pleaded for Charlie, who had suffered severe brain damage and was unable to breathe unaided and as a result needed the ventilator, to remain on life support. His parents appealed to the court because they disagreed with the doctors and believed they should not withdraw his life support. The court decided for the best interest of Charlie that the life support would be turned off. This case is an excellent example of how mechanical ventilation can help prolong someone’s life, but the person’s condition shows no signs of improvement. Should we prevent them from suffering even more, or take that chance that they could be able to recover? Medical decisions are never easy and are not as straight forward as they seem.

Another way in which one can prolong their life is through organ transplantations. In December 1954, the first successful kidney transplant took place by Dr Joseph Murray and Dr David Hume in Boston, United States. Even though there had been many failed attempts previously, this was the first successful operation. Transplantation has become increasingly popular and popular with more than 95% of kidney transplant patients surviving beyond a year. Organ Transplant gives another opportunity for patients who suffer from a damaged organ. The NHS has reported that after 28 years, in 2018, there was the highest number of organ donors. Even though organ transplant provides a second chance for many patients, a study conducted by Stanford Medicine School showed that almost 25% of kidney recipients and 50% heart recipients experienced acute rejection after the first year of their organ transplant. This suggests that this clinical intervention does not always guarantee the best outcome for the transplant recipients.

However, clinical intervention has given many patients another opportunity at life. Death is defined as the cessation of the circulatory and respiratory system, but what if we could improve the quality of our experience and prolong it? One is usually classified as dead when their heart stops beating, but what if we can extend their life? The first heart transplant took place on December 3rd in 1967 by a South African Surgeon called Christiaan Barnard in Cape Town. The patient survived for 18 days, and Dr Barnard’s second patient, Philip Blaiberg, lived for nearly two years. A year later, the first heart transplant in the UK took place on May 3rd, 1968. Although heart transplantation is a successful therapy to save those patients suffering from irreversible heart failure, the sad truth is that there is a lack of organs. The unavailability of healthy organs for transplantation has resulted in a significant organ shortage crisis. In the United States of America, the number of patients on the waiting list in 2006 was greater than 95,000, whist the number of patient deaths was just over 6,300. The organ shortage has deprived many of better quality of life and instead caused them to resort to alternatives such as dialysis. Nevertheless, there is still hope, as the ‘artificial organ market may achieve around 9% CAGR (compound annual growth rate) up to the year 2025’ potentially increasing the number of patients in need of organ transplant and improve their way of living. Even though it is expensive, it provides another alternative and can potentially help lengthen life, temporarily beating the battle against death.

Finally, a much newer example of extending life is by being cryogenically frozen. This is the freezing and storage of a human corpse, with the hope that a person may come back to life in the future. Even if currently there are no ways to combat certain diseases and fight against some medical issues, by being cryogenically frozen, there is a chance of being brought back to life if there was to be a cure in the future. The first person to be cryonically preserved was James Hiram Bedford, who died of cancer in 1967. Although we can cryonically preserve a person, we still need to figure out how to bring the person back again. If this succeeds, we will have to rethink the definition of death, as this is beyond anything we have seen before now. In February, a scientist in California successfully cryonically-preserved the brain of the rabbit. When he thawed it, Dr Kenneth Hayworth said ‘Every neurone and synapse looks beautifully preserved across the entire brain.’ This gives hope for this research, and this can potentially rewrite the future.

It is evident that as technology has advanced and our knowledge of human science has increased, the line between death and life is beginning to merge. Someone who may be brain dead (emotionally inactive) may still have a normal, fully functioning body. Similarly, someone who may have had an organ failure which could have potentially caused their death is now alive thanks to organ transplantation. It is thrilling and exciting to see what the future holds for this area of medicine and how many medical discoveries would change what we view as normal. Maybe in the future, death is something we could be able to overcome.

Piriyanka Jeyapahan

Published by Piriyanka Jeyapahan

I am interested in pursuing a career in this exciting field of medicine. I find it fascinating and eye-opening to see how changes in medical innovations can rewrite the normal way of living. The idea of discoveries changing and benefitting patients excites me. I am excited to see what the future beholds and how medicine may change.

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