There's a difference between being in a coma and a vegetative state. The stories confusing the two are hindering organ donor education.
A day rarely goes by that I don't read a few sensational headlines: "Man Declared Dead Feels 'Pretty Good'" or "Husband Celebrates Miracle as 'Brain Dead' Wife Wakes Up in Hospital." I recently read an article that seemed to describe a man on death row in Huntsville, Texas. It attempted to shock its readers with the claim that a college student had been declared brain dead and "just hours before he was slated to be killed and his organs given to another patient," he miraculously recovered. That's right, they said "killed."
As a neurologist who specializes in brain injury, I have cared for many brain-injured patients and there were times when they did better than I anticipated, but sensational articles like these only confuse the public. During the health care legislation debates, the mere mention of insurance coverage for consultation on end-of-life decisions brought forth hysterical cries of "death panels" from people like Sarah Palin who exhorted that "my parents or my baby with Down's Syndrome will have to stand in front of Obama's 'death panel'...." But if the headlines are fiction, what is the truth?
It can be difficult to predict a person's outcome after a severe brain injury, but it can be said with certainty that a brain dead individual is dead.
HOW OUR BRAIN ACTUALLY WORKS
Brains are far more complex machines than even the most sophisticated computer. We turn on our computer with a simple switch. The screen entertains us as it boots up and we start to check our email, linger on Facebook to catch up with friends, or read the latest headlines. Have you ever wondered what your brain is doing in the early morning as you awaken to your automatic coffeemaker brewing that first cup of joe?
The main part of our brain, the cerebrum, sits inside our skull and is attached to our spinal cord by the small, but critical, brain stem. Inside the brain stem is a small, but critical, group of nerve cells known as the Reticular Activating System (RAS) that send messages up into the brain, not only to wake us up, but also to keep us alert. We call this process arousal -- no, not that tingling that you get when you kiss the man or woman of your dreams, but stimulation that keeps you awake. But just being awake isn't enough.
We need an intact upper brain to be aware of ourselves and our surrounding environment. Awareness is a higher-level function that requires areas of the cerebrum to process the information we see and hear. A patient may have their eyes open and look like they're awake, but if the brain is severely damaged they may have no awareness of their surroundings. We call this a vegetative state.
On the other hand, people who are in a coma are not awake and have no awareness of themselves or their environment. You can talk to them, pinch them, show them pictures of their family -- they will not respond. However, these patients are not brain dead. This is the source of the confusion that leads to the sensational headlines and stories.