Brain death diagnosed by forensic analgsis of drug distribution in human tissues

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ln order to diagnose the brain death, caffeine cmcentrations in human tissues of 6 brain death cases as well as 5 non-brain death cases were examined. Concentrations of caffeine in human tissues were determined using gas chromatography/mass spectrometry. The tissue-to-blood concentration ratios were used to evaluate the distribution pattern in each case. In non-brain death cases, the ratios in every tissue were stable, and the values were close to 1 in all tissues except adipose, of which value was near 0.3. In brain death cases, the ratios in all tissues except brain and adipose were similar to those in non-brain death cases. The ratios in the brain were higher than those of non-brain death cases, in 5 brain-death cases, and lower in 1 brain-death case where blood transfusion wes done in a hospital. The ratios in the adipose were slightly higher than those in non-brain death cases. These discorded distribution in the brain death cases was likely related to cessation of blood circulati … More on in the brain at the time of brain death. Therefore, comparing caffelne concentrations in the brain with those in the other tissues were useful for the forensic diagnosis of brain death. We examined the distribution of drugs in a 49-year-old brain-dead man. Our objective was to determine the possibility of diagnosing how and at what point the patient became brain dead. The presence of mepivacaine, pentazocine, lidocaine and thiamylal in various tissues, including 7 regions of the brain were confirmed, using gas chromatography-mass spectromefry. Tissue-to-blood concentration ratios of mepivacaine, pentazocine and lidocaine in the brain were higher than theseratios in other tissues, while ratios of thiamylal were lower. Therefore, cerebral blood flow was likely to have ceased between the administration of the former drugs and that of the latter drug, in agreement with clinical records. Among 7 regions of the brain, the ratios of the former 3 drugs were high in occipital and parietal lobes, and were low in the cerebellum and meduua oblongata. On the other hand, the ratios of the latter drug were high in the cerebellum and the medulla oblongata. Therefore, cerebral blood flow presumably ceased fast in occipital and parietal lobes, and last in the cerebellum and he medulla oblongata. Based on these results, assessment of concoitrations of drugs in human tissues, Including various regions of brain is useful to determine the time and progression of brain death. Less