How to define death ?

Defining death can be difficult because of differing concepts based on context; namely religious, cultural, legal or scientific. For Brain stem death ( BSD ) , the context is scientific. Defining death as the biological event that marks the transition from being alive to being dead is hard to argue against but is unhelpful because it does not provide criteria that describe what is meant by being alive or being dead. Death is the permanent cessation of the critical functions of the organism as whole'.

In the United Kingdom (UK), BSD is defined as irreversible loss of consciousness, irreversible loss of the capacity to breathe and irreversible loss of integrated functioning. The UK definition has merit because it permits criteria to be derived that are not only explicit but also testable. The inclusion of irreversible loss of integrated functioning implies death of the organism as a whole, not the whole organism. It is important to recognise that currently, whatever criteria and tests are chosen, we are only able to diagnose the state of being dead, not the event of death.

Worldwide, two distinct mechanisms of death are recognised; namely irreversible cardiopulmonary arrest and Brain stem death (BSD) or Brain death (BD). Scientifically, this distinction is artificial. Cardiopulmonary arrest only causes inevitable death if the brain stem is irreparably damaged due to lack of perfusion with oxygenated blood. Thus, the key feature of both mechanisms is irreparable brain damage. The two mechanisms differ only because death is diagnosed in the presence or absence of a beating heart.

Unfortunately, the general public normally associates death with cardiac standstill. This is an emotive issue and is most easily discussed in the context of heart-lung transplantation patients receiving extracorporeal membrane oxygenator support. These patients are alive despite the fact that the diseased heart and lungs have been removed. Their brains are capable of integrated function and the patient would be fully conscious were it not for the fact that anaesthesia is administered.

Many relatives find brain death easier to accept if it is explained that although the brain relies on the heart to circulate oxygenated blood, this function can be replicated by machines. In contrast brain function cannot be artificially replaced and the heart always stops within days or weeks of the brain stem dying.

By diagnosing BSD, we have not changed the nature of death. We have, however, improved our diagnostic skills and moved the time that we diagnose the state of being dead closer to the time when death actually occurred.

Tips for patients with Diabetic Kidney Disease

• Round the clock blood sugar control
• Blood pressure control (below 130/80)
• Give up smoking / tobacco chewing
• Urine test for micro-albumin
• Eye test for retinal damage , laser treatment if needed
• Heart check up
• Care of feet
• Diet control of sugar ,salt ,fat and protein ( under doctors’ supervision )
• Avoid pain killer drugs
• Occasional appropriate blood and urine tests

symptoms of diabetes

• Frequent urination
• Increased thirst
• Unexplained weight loss
• Weakness and fatigue
• Numbness or tingling in the limbs
• Blurred vision
• Dry, itchy skin
• Frequent infections
• Slow healing of cuts and bruises
• Swelling of feet and frothing of urine may indicate kidney disease.

Diabetes and Kidney Disease

On World diabetes Day

Indian healthcare’s Dangerous Duo

By Dr S.J.Acharya

As per the International Diabetes Federation, worldwide more than 285 million people now live with diabetes. With every sixth diabetic an Indian, India is truly the world’s Diabetes Capital with 50.8 million diabetics. China follows with 43.2 million and the US with 26.8 million. Sedentary lifestyles, delays in early detection and lack of proper treatment are all contributing to the life-threatening rise in diabetic cases.

Diabetes is a condition where the body either does not produce enough insulin or does not respond properly to insulin – a hormone produced in the pancreas. When insulin is no longer produced or it is ineffective, the glucose cannot enter the cells and keeps circulating with increased levels in the blood. This is where the problems begin.

High level of sugar is poisonous for cells . That is why we find high incidence of cataract , blindness, heart disease , leg problems , kidney problems and problems related to nerves in diabetic patients . All these could be avoided if blood sugar is kept under reasonable control .

Blood pressure tends to be high in diabetics due to stiffening of blood vessels – a result of high level of fat in blood in diabetics . Blood pressure further damages heart , eyes and kidneys . So a diabetic must have a better control of blood pressure .

Smoking and tobacco chewing add salt to the injury . Diabetic smokers are prone for gangrene of legs . In the world , every twenty minutes a diabetic faces amputation of a limb due to gangrene.

Kidneys bear brunt of diabetic assault . Kidneys are damaged easily with high blood sugar and blood pressure . Kidneys are rich in blood supply . The kidneys comprises of millions of tiny filters or nephrons. In turn, the nephrons have even smaller vessels within them. The kidneys constantly remove wastes and toxins from the bloodstream. When glucose levels in the bloodstream are consistently too high, the nephrons (filters) are slowly destroyed. The kidneys can no longer filter the blood, and wastes that would be excreted keep circulating in the bloodstream. Gradually, this gives rise to Chronic Kidney Disease.
Unlike heart attacks which manifest with chest pain , kidneys bear the assault silently for years . And by the time a physician detects kidney problem , its too late and irreversible .

The manifestation of diabetic kidney disease are swelling of face and feet , weakness , nausea , vomiting , itching , bony pains , menstrual disturbance , loss of sexual urge , inability to concentrate etc . Anemia , high blood pressure and eye problems are invariably associated .
Laboratory tests reveal protein in urine , rise in urea and low haemoglobin

Diabetics should undergo periodic or annual screenings to check kidney functions and detect kidney disease in time.

Although chronic kidney disease is not reversible, a treatment regimen and medical intervention is necessary so toxins do not build up within the body. Along with strict glucose control, taking medications to control blood pressure and eating a low-protein diet to reduce stress on the damaged kidneys.

In severe cases of chronic kidney disease , dialysis may be required to flush out toxins and clean the patient’s blood. Dialysis is a three- or four-hour process that needs to be repeated every few days. There are two types of dialysis:
• Haemodialysis: A machine filters the patient’s blood thrice a week. The procedure takes three to four hours and must be done at a dialysis centre.
• Peritoneal dialysis: This can be performed independently at home. Here the blood is not filtered directly, but via the abdomen using fluids instead. Some patients find this more convenient.


Another treatment of chronic kidney disease is kidney transplantation . But finding a suitable family member for kidney donation is difficult in diabetics because most of the family members turn out to be diabetic and hence not suitable for kidney donation . Also presence of other complications like heart disease often makes a diabetic patient unfit to undergo transplant surgery . However kidney transplantation in selected patients is the most appropriate treatment for diabetic kidney disease .


The urine of diabetics has high sugar content, which encourages growth of bacteria, leading to kidney infections. Diabetics must take special care and treat infections promptly.

Finally, people with diabetes and CKD must have a carefully controlled diet, drawn up in consultation with their doctor. So rather than following a troublesome list of do’s and don’ts, it makes perfect sense to control your diet now and exercise daily to prevent diabetes and diabetic kidney disease in the future.



(Dr S.J.Acharya is eminent kidney and transplant physician in Central India and also founder secretary of Central India Kidney Foundation )

Acharya Dialysis Centre And Kidney Hospital

Acharya Dialysis Centre & Kidney Hospital is situated at Dhantoli , opposite Anand Ashram , near garden on Abhyannkar Road , Dhantoli .