The ethics of donation and transplantation: are definitions of death being distorted for organ transplantation?

A recent commentary defends 1) the concept of 'brain arrest' to explain what brain death is, and 2) the concept that death occurs at 2–5 minutes after absent circulation. I suggest that both these claims are flawed. Brain arrest is said to threaten life, and lead to death by causing a secondary respiratory then cardiac arrest. It is further claimed that ventilation only interrupts this way that brain arrest leads to death. These statements imply that brain arrest is not death itself. Brain death is a devastating state that leads to death when intensive care, which replaces some of the brain's vital functions such as breathing, is withdrawn and circulation stops resulting in irreversible loss of integration of the organism. Circulatory death is said to occur at 2–5 minutes after absent circulation because, in the context of DCD, the intent is to not attempt reversal of the absent circulation. No defense of this weak construal of irreversible loss of circulation is given. This means that paents in identical physiologic states are dead (in the DCD context) or alive (in the resuscitation context); the current state of death (at 2–5 minutes) is contingent on a future event (whether there will be resuscitation) suggesting backward causation; and the commonly used meaning of irreversible as 'not capable of being reversed' is abandoned. The literature supporting the claim that autoresuscitation does not occur in the context of no cardiopulmonary resuscitation is shown to be very limited. Several cases of autoresuscitation are summarized, suggesting that the claim that these cases are not applicable to the current debate may be premature. I suggest that brain dead and DCD donors are not dead; whether organs can be harvested before death from these patients whose prognosis is death should be debated urgently.     

Cognitive estimations as a measure of executive dysfunction in childhood epilepsy

Children and adolescents with epilepsy are known to demonstrate executive function deficits. Despite prior work that has shown that cognitive estimation tasks are sensitive to executive dysfunction in children, such tasks have not been studied in children with epilepsy. This is particularly important given the fact that executive tasks have heretofore shown poor ecological validity, and it has been speculated that estimation tasks may show stronger ecological validity than other executive tests. One hundred and thirteen clinically referred children and adolescents with epilepsy were included. The Biber Cognitive Estimations Test was sensitive to cognitive dysfunction, with about half showing impairments on this task in comparison to age-matched normative data; the most frequently impaired subscales were quantity estimation and time estimation. Moreover, the Biber Cognitive Estimation Test showed moderate correlations with not only overall intellectual functions and academic achievement but also other commonly administered tests of executive functions, including digit span, Trailmaking, and the Tower of London but not with the contingency naming test. Cognitive estimations were also modestly correlated with age of epilepsy onset but not other epilepsy-severity variables such as number of antiepilepsy drugs (AEDs) or seizure frequency. Unfortunately, the hypothesis that the Biber Cognitive Estimation Test would show strong ecological validity was not supported, as it showed weak relations with parent-reported executive function deficits. The significance and limitations of this investigation are discussed.     

The influence of semantic property and grammatical class on semantic selection

Research to-date has not successfully demonstrated consistent neural distinctions for different types of ambiguity or explored the effect of grammatical class on semantic selection. We conducted a relatedness judgment task using event-related functional magnetic resonance imaging (fMRI) to further explore these topics. Participants judged relatedness within word pairs. Consistent and inconsistent conditions were included along with filler items. Imaging results revealed a main effect of ambiguity in the dorsolateral prefrontal cortex (DLPFC) and parietal cortices. A main effect of grammatical class was observed in the parahippocampal and lingual gyri, and a main effect of consistency was found in the DLPFC, ventrolateral prefrontal cortex (VLPFC) and occipital cortices. Interactions among these factors were observed in the cingulate gyrus and motor cortices in addition to the DLPFC. These results suggest that both ambiguity type and grammatical class modulate semantic selection through different neural regions.     

RACE DIFFERENCES IN TERMINATION AT WORK: THE ROLE OF EDUCATIONAL INEQUALITY

Prior research has demonstrated that race, at least to some extent, is related to employment decisions such as selection and performance appraisals. However, little prior research has addressed the impact of race on employment termination. The current study investigates whether race is related to employment termination and highlights the importance of education, an important component of human capital, in understanding racial differences in termination. Results based on 548 employees from a large hotel chain indicate that race is related to termination; however, race is not predictive of termination when education is included in the regression analysis as a predictor. These findings support the notion that a societal level variable (i.e., education) is an important factor in reducing racial inequality in employment practices.