Chapter 236: Brain Death (1) |
The past two weeks of preclinical experiments were nothing but miraculous.
‘This experiment is magnificent.’
That was the thought Cheon Ji-Myung had on the day the beagle raised its head and grunted.
The Life Creation Team who carried out the entire experiment themselves, Carpentier, Song Ji-Hyun, and the cell experiment experts at Cellijenner all knew that this wasn’t just a remarkable achievement or an outstanding result; humanity was touching the line related to the secret of life.
“We removed a part of the skull outside the occipital lobe, and then injected chloroform and ethanol with a microsyringe to wipe out all brain function. Then, we attached a cardiopulmonary support device to the beagle to restart the heart to keep it alive,” Young-Joon said.
“We harvested the beagle’s somatic cells and created induced pluripotent stem cells. We injected about one hundred thousand of them under the fourth ventricles and administered dopamine, epinephrine, ATP or glucose, to differentiate the stem cells. The fourth ventricle is the organ that is responsible for repairing damage to the brainstem, and the stem cells placed here will differentiate into the neurons that make up the brainstem."
Young-Joon flipped through the slides.
For the last two weeks, everything about the beagle was recorded on video. Not a second was missing. Young-Joon had also included the electroencephalogram and the fMRI data.
He presented them on three separate screens.
The video now showed the blood flow in the lower part of the beagle’s brain in red.
“The beagle’s heart keeps beating through a life support system. The stem cells injected into the ventricle have differentiated due to dopamine and produced a K11 signal, which dilates the blood vessels. This allows the blood that flowed from the heart and through the cerebral artery to collect at the ventricle,” Young-Joon explained. “And this is the result.”
Young-Joon pointed at the electroencephalogram on the other screen. The amplitudes are small, but it has picked up delta waves, a type of brain wave.
“Now, I will speed up the video.”
Young-Joon sped up the video to a thousand times its original speed.
There was one thing that showed up too much in the video: even though the video was a thousand times its speed, Song Ji-Hyun and the Life Creation Team were constantly on the video. Everyone could feel that these scientists worked on this experiment day and night, basically having no personal lives.
Click.
Young-Joon paused the tape for a moment.
“The beagle is still unable to move, but a lot of things are happening on the fMRI. Can you see this?”
Young-Joon pointed to the fMRI video.
“The blood flow to the medulla was fluctuating, but it stabilized after six hours.”
The medulla was an extension of the spinal cord, located at the very bottom of the brain. It was also the most important part that was responsible for life.
It contained all the ascending and descending nerve tracts that connected the brain and the spinal cord. Out of the twelve pairs of brain nerves, ten of the peripheral nerves, excluding the optic nerves, went through the medulla.
“The reason the medulla is important is because it contains the core of the autonomic nervous system that controls things like breathing, beating of the heart, and gastrointestinal activity. This means that living beings can breathe, beat their own heart, and digest food on their own. These functions are the basis of life, and they are the last to be lost before death,” Young-Joon said.
“As such, we predicted the possibility of the medulla recovering its function when blood began to rapidly flow there, and we injected two chemicals that dye cells to visualize whether the nerves were recovered. The red one is propidium iodide, which dyes dead cells, and the blue is live cell DAPI, which dyes living cells. They can both be observed with a fluorescent microscope. Now, I will show you the data.”
Young-Joon played the video that was taken forty-four hours after administering the due. There was a very small number of blue cells at the very bottom of the medulla. But ninety-nine percent of the medulla was red.
“It is showing up as red because the medulla of the beagle was already dead,” Young-Joon explained.
But as time went on, the blue cells began to increase and expand into the upper region. The magnification of the microscope was very high, and they could even see the cytosol, the outer part of the nucleus, of the blue cells.
Over the course of two days, the blue cells stretched out like string cheese. They expanded their power towards the upper region aggressively.
“Wow…”
Not just the citizens, but even the experts who were invited to represent the opposition exclaimed in amazement.
And when thirty-eight hours had passed…
Beep!
One of the nerves in the medulla began emitting a strong blue fluorescence.
The broken engine had fired back up.
The nucleus of one of the autonomic nerves in the growing medulla had finally succeeded in secreting adrenaline and communicating with the sinoatrial node, a cluster of muscle cells in the heart.
The sinoatrial node was like the heart’s local government. They received messages from the brain and regulated the heartbeat. The sinoatrial node hadn’t been functioning properly because the medulla, which was like the federal government, hadn’t been working. The machine was just sending electrical signals to the heart to make it beat.
But now, the new government established in the medulla was connected to the local government of the heart. The node now received biological signals from the heart and began to manage it.
Young-Joon reset the video’s speed back to normal. Then, Carpentier slowly removed the beagle’s pacemaker in the video.
Beep. Beep. Beep.
However, the electrocardiogram on the monitor still showed a steady heartbeat.
“Now, this beagle is entering a persistent vegetative state similar to humans,” Young-Joon said.
[Brain death is not really death.]
[We can now revive brain-dead individuals.]
[A-GenBio succeeds in recovering a brain-dead patient to a persistent vegetative state.]
News articles were pouring in real time. The world was becoming noisy, but the public hearing continued.
Young-Joon started the video again and continued to explain the experiment.
After the function of the medulla was restored, things took off from there. Nerve cells that were dyed blue also grew in the pons and the midbrain, the other key organs that made up the brainstem.
And the growth of these cells didn’t stop there. Soon, they occupied and connected the junction of the diencephalon at the top of the brainstem and the cerebellum at the back. Mysteriously, as the brainstem’s function was restored, neural signals began to fire intensely to the frontal lobe of the brain. It was waking up sleeping brain cells in the cerebrum.
And on the ninth day…
“Wow!”
An exclamation of astonishment erupted from the audience.
The beagle in the video had opened its eyes. The beagle had come back to life after suffering from a deadly condition caused by the loss of function of the brainstem.
The poor animal let out a grunt and licked Cheon Ji-Hyum’s fingertips.
“...”
Hong Jung-Ho and other opposing experts were speechless at the unbelievable sight.
“Death is a much more elusive concept than we realize,” Young-Joon said. “For example, a patient with a problem in the sinoatrial node of the heart will die within minutes because the heart no longer beats, but modern medicine can save them by surgically implanting an artificial pacemaker under the left collarbone.”
Young-Joon pulled up a diagram of how a pacemaker worked and how it was operated.
“This machine has a built-in battery. Wires are connected to the heart to help it beat. It takes over the role of the failed sinoatrial node, and the pacemaker can be used for ten to fifteen years without having to be replaced,” Young-Joon said.
“In the past, the loss of function of the heart’s sinoatrial node was understood to be a form of cardiopulmonary death. Because the technology didn’t exist, patients with damaged nodes were considered dead because their hearts weren’t beating. But not now.”
Young-Joon closed the data pile.
“What point should be considered death depends on the level of technology and what science understands. If the definition of death changes and the concept of brain death is removed from death, it doesn’t really change that much,” Young-Joon said. “It just allows us to understand humans and the world more precisely, and that’s what science does. Now, let’s watch the last point in the video.”
Young-Joon fast-forwarded the recording again.
By the thirteenth day, the beagle was off all life-support machines, even the intravenous fluids. On the fourteenth day, the beagle ate some kibble that was softened like porridge, though it still couldn’t stand up.
“This is the end of my evidence. The same experiment was repeated on a total of seven beagles, and no adverse effects were observed.”
Young-Joon finished his statement and sat down. Everyone mumbled for a while, and the media was rushing to report that the beagles had come back to life and were licking the food.
The lawmakers seemed quite surprised by the unconventional hearing. The debate was full of biology jargon: although they didn’t understand many of the details, they got the gist of what was going on.
“Opposition, please speak.”
The speaker continued the debate.
“I…”
Hong Jung-Ho, the expert from the opposition, hesitated to speak.
“I’m not sure…” he said. “I don’t know how to take in something like this. Brain-dead individuals have been medically declared dead for a long time. We’ve known that the heart just beats mechanically by life support, but the person is biologically dead…”
He bit his lip.
“For years, surgeons stopped treating the brain-dead when their electrocardiograms peaked, their bodies were warm, and we were pumping their lungs with a respiratory device,” he said.
Unlike cardiopulmonary death, which showed a straight line on an electrocardiogram with a long beep, the brain dead still had a signal when they were pronounced dead. From the outside, it really looked like they were just sleeping. There were no signs of death except that the brain was not generating any electrical signals. At that point, doctors would remove the respiratory machines and perform open surgery to remove their organs and transplant them to another patient. This kind of task was daunting, even for a doctor.
The reason this was possible was because they were confident in their medical opinion that the brain-dead person was really dead. By the time the electrocardiogram eventually stopped after several weeks, the organs would already be damaged and have the possibility of causing problems in the transplant recipient.
“But if they were alive…”
Horrendous thoughts were going through the doctors’ heads.
“There’s no need to blame yourselves. It was true that there was no way to reverse brain death,” Young-Joon said. “There’s a difference between being unable to treat and stopping treatment,” Hong Jung-Ho said. “Doctors have been murdering…”
He covered his mouth, feeling choked up.
“Medicine has only done its best to save those who could be saved.”
Young-Joon summarized Hong Jung-Ho’s remarks.
“And that best has now been extended a little further. We can provide artificial organs to the vast number of organ transplant recipients who are dying waiting for organs from brain-dead people. Now, it looks like we may be able to treat brain-dead patients as well,” Young-Joon said. “This is why we need this special act to pass. Please pass this bill.”