“Brain Death Examination” by David Urion, MD and Robert Tasker, MBBS, MD for OPENPediatrics


Brain Death Examination by Dr. David Urion
and Dr. Robert Tasker. Healthcare workers in all healthcare settings
should always adhere to the latest World Health Organization guidelines on hand hygiene and
barrier precautions, before and after contact with a patient, bodily fluids, or patient
surroundings. For more information, please watch our video entitled Hand Hygiene. Introduction. Hello. My name is Robert Tasker. I’m the chief
of the NeuroCritical Care Program. This is David Urion. And I’m the director of the residency programs
in child neurology and neurodevelopmental disabilities and one of the physicians that
serves on the neurology critical care consultation team here at Children’s Hospital Boston. What we’re going to do today is demonstrate
the brain death examination in this 7-year-old boy. Typically, we would do this examination
as a pair. It’s important that the neurological examination is done by two different individuals.
The apnea test can be done by the same person. The clinical aspects of the brain death examination
are fundamentally the neurologic examination. It’s targeted at two particular issues. One
is the investigation of coma. And the other is the investigation of brain stem reflexes. For the diagnosis of brain death to be made,
we would expect that there would be no discernible clinical response that could be attributed
to the cortex– that is profound coma– and no discernible responses to interrogating
the brain stem through a variety reflexes that we’ll demonstrate. Certain conditions, however, need to be met
before one could even consider doing this examination. These patients must have a history
of traumatic, anoxic, or metabolic brain injury and a progression of that injury over a period
of time that could explain the events we are investigating. We need to make certain that the patient meets
certain parameters, in terms of blood pressure, oxygenation, temperature, and also the absence
of any kind of sedating or intoxicating compounds, chemicals, or drugs and the absence of any
neuromuscular blocking agents. In any of those instances, we cannot proceed ahead with this
investigation. All institutions have a set of checklists
that they use, in terms of making the determination. And we’d encourage you to use that at the
bedside to make certain that nothing gets left out and that you proceed in an orderly
fashion with the examination. We’ll refer to the set of guidelines that are used as
practice parameters here at Children’s Hospital. Equipment. You will need the following equipment to perform
the procedure- reflex hammer, flashlight, cotton-tipped swab, tongue depressor, 60-milliliter
syringe, kidney basin, ice cold water, towel roll, arterial blood gas, oxygen source, T-piece,
suction catheter. Investigation of Coma. The first thing we’ll do is examine the patient
and see that in point of fact, as we look up here, his heart rate is 110. His blood
pressure is 89 to 85 over the 50s. And his oxygenation is at 100% by pulse oximeter.
That’s all of the metabolic conditions. And his temperature has also been demonstrated
to be above 36 degrees would be present so that we can proceed with this examination.
And you’ll have to take our word for it that we’ve interrogated the chart and made certain
that there is no explanatory findings of sedating medications, neuromuscular blocking agents,
or things of that nature. First thing we would do is to see if we can
discern any response from the patient at all. We’d say, “Hhello, hello, hello, hello young
man.” In the absence of that, we’d then see if more vigorous stimulation would provoke
any kind of response from him at all. In the presence of decorticate or decerebrate posturing,
we know, then, that parts of the nervous system are still intact. And therefore, the diagnosis
of brain death can’t be made. It’s important to remember, however, that
there are certain automatic responses that don’t constitute anything from the brain itself.
For example, a so-called triple flexion response– flexion at hip, knee, and ankle– is an involuntary
spinal response and doesn’t constitute any kind of a meaningful response from the brain
itself. And so, in this instance, the first thing
we would do is a moderately painful stimulus– for example, here at the toes. Any other number
of things can be used to generate a painful stimulus. You can put your reflex hammer in
between the toes, holding onto them and twisting like this. We then look to see if there’s
any autonomic response. And we see that, while I’m doing this, his heart rate is completely
invariant and making no change at all. Finally, we’d lift back his eyelids. And we’d
look to see if there’s any pupillary response to this at all– again, an autonomic nervous
system change that might suggest intactness of certain parts of the thalamocortical connections.
And in this instance, there’s none. Painful Toe Stimulus. A normal response to the application of a
painful stimulus to the toes is that the patient should withdraw his or her foot, as seen here.
An abnormal response is when a patient does not withdraw his or her foot, as demonstrated
here, nor does he or she demonstrate any autonomic or pupillary response to the stimulus. Similarly, we can grab the nail bed and squeeze
here. Again, seeing if there’s any kind of pupillary response in our patient. And again–
looking for any kind of autonomic nervous system response or voluntary motor response.
And again, we see none. Painful Nail Bed Stimulus. A normal response to the application of strong
pressure, to any of the nail beds, will be that the patient should withdraw his or her
hand, as seen here. An abnormal response is when a patient does not withdraw his or her
hand nor does he or she demonstrate any autonomic or pupillary response to the stimulus. Investigation of Brain Stem Reflexes. Next, we would interrogate the brain stem.
And the first thing we would do is to see if there is any pupillary response. So the
pupils, at this point, are mid-position, fixed, and dilated with no response to light. Pupillary Reflex. With a normal and intact pupillary reflex,
you will observe that the patient’s pupils are mid-position and constrict in response
to bright light. An abnormal pupillary reflex will be demonstrated by pupils that are mid-position,
often dilated, and do not constrict in response to bright light. It should be noted that certain
conditions can make it difficult to assess the pupillary reflex, including preexisting
pupillary abnormalities, such as coloboma, topical administration of certain medications
to the eye, such as atropine or phenylephrine trauma to the eye. Finding that there was no pupillary response,
the next thing we would investigate is to see if there’s a corneal response. We would
do this by getting some form of a cotton tip– easiest if you pull it just a little bit so
we have a small tuft out here– and then applying it to the side of the cornea like this– see
if there’s any kind of an aversive response– blink, anything that suggests intactness of
this sensory stimulus. And again, we see, on both sides here– no response. Corneal Reflex. With the normal and intact corneal reflex,
you will observe that the eye will blink when you touch a cotton swab to the cornea. An
abnormal corneal reflex will be demonstrated by an absence of blink when a cotton swab
is applied to the cornea. After this, we would do oculocephalic maneuvers.
That is, we look to see if the eyes can maintain themselves in an attempt midline while I turn
the head. So we would never do this examination in anybody who we anticipate, or might be
worried, has a cervical spine injury. But having looked at the chart, we know that this
young man doesn’t. And so, we would turn his head smartly to
one side. And see if, in fact, there’s an attempt to get the eyes back to midline. And
we would then do it to the other side. And again, there is no such response. Oculocephalic Reflex. This is sometimes called the doll’s eye reflex.
With a normal and intact oculocephalic reflex, you will observe that, when you turn the patient’s
head quickly to one side, the eyes will move to remain fixated on one position in space.
In patients with an abnormal oculocephalic reflex, you will observe that, when you turn
the patient’s head quickly to one side, the eyes will remain mid-position. It should be noted that this reflex can be
difficult to assess when there is significant orbital edema, impairing the ability of the
examiner to open the eyes, or with significant conjunctival edema, impairing the ability
of the eyes to move appropriately. We would next try to stimulate this through
caloric testing or oculovestibular reflexes. And for that, you need to have some preparation.
The head of the bed needs to be at roughly 30 degrees so we can have the semicircular
canals orthogonal to gravity. It’s always a good idea, since we’re about to put water
into the bed itself, to put a towel under here to catch what might flow out of my basin. We then fill this basin with ice water. And
we would take, into a syringe, 50 ccs of ice cold water, a very profound stimulus of the
oculovestibular network. Before we go ahead any further, we would take an otoscope and
examine the ear to make certain, first of all, that there is no wax blocking the pathways
so that we, in fact, really are going to stimulate the tympanic membrane and also make certain
that there’s no other pathology there that would make us not want to do this test. So I’ll investigate on this side. And then,
just so I have to climb around the desk, Dr. Tasker, to look in the other side to make
certain that the tympanic membranes are intact and visible. That being the case, we would
then go ahead. And I’ll ask Dr. Tasker to hold back his eyelids
so we can watch. We’ll position the basin just behind the ear, like this. And then,
we would insert the tubing. You can make this from any kind of an IV tubing, just removing
the needle. And we would then, as rapidly as we can, instill 50 ccs of ice water into
this space. Now, what we’re looking for is half of what
would be usual caloric nystagmus. Remember that nystagmus is named after its fast phase,:
coldalled- opposite, warm- same, since the fast phase is the cortical reset. And we’ve
already demonstrated that there are no cortical responses. We’d be looking for the brain stem
half of this response, which, in this instance, would be the eyes turning toward the cold
water stimulus. And we would put in these 50 ccs and wait roughly 90 seconds to 120
seconds and see that there’s no response. We’d then come around and do the same thing
on the other ear, again, making certain that the eyes begin at midline. And we would rapidly
install 50 ccs of ice cold water into the ear
and look for any response, waiting for a period
of time. And again, we see none. Oculovestibular Reflex. With the normal and intact oculovestibular
reflex, when you instill cold water into the otic canal, you will observe that the eyes
turn quickly away from the cold water stimulus and, then, turn slowly toward the cold water
stimulus in a repetitive manner. Therefore, if you instill cold water into the right ear,
the fast phase of eye movement will be toward the left side and the slow phase of movement
will be toward the right side. This is a normal, physiologic response, known as nystagmus.
After instilling cold water into the ear, you may need to wait 90 to 120 seconds to
observe for any response. For patients in which there is a lack of cortical
response, based on earlier tests, the brain stem may still be intact. When you instill
cold water into the otic canal, if the brain stem is still intact, you will observe the
eyes turn slowly toward the cold water stimulus. Therefore, if you instill cold water into
the right ear, the eyes will turn slowly toward the right side. After instilling cold water
into the ear, you may need to wait 90 to 120 seconds to observe for any response. If the brain stem of the patient is not intact,
when you instill cold water into the otic canal, you will observe that the eyes will
not turn toward the cold water stimulus. Therefore, if you instill cold water into the right ear,
the eyes will stay mid-position. After instilling cold water into the ear, you may need to wait
90 to 120 seconds to observe for any response before concluding that there is no response. Remember that cerumen in the otic canal will
prevent the cold water from reaching the tympanic membrane. And thus, you will not be able to
assess this reflex. The last part of the examination would be
to examine the lower brain stem by looking for any kind of oropharyngeal response. We
might do this by suctioning the patient or, alternatively, taking a tongue blade or a
cotton swab, like this, and inserting it deep into the back of the throat. We’d be looking
here for any kind of palatal elevation or response in any of the musculature in the
retropharyngeal area. And we see that there’s none. Pharyngeal Reflex. With a normal and intact pharyngeal reflex,
when you insert a tongue blade deep into the back of the patient’s throat, you will see
that the palate will elevate. In patients with an abnormal pharyngeal reflex, when you
insert a tongue blade deep into the back of the patient’s throat, you will see no response
by the musculature in the retropharyngeal area. Clinical Pearl. Alternative Pharyngeal Reflex. Another way to investigate the pharyngeal
reflex is to perform stimulation of the carina. Some providers feel that patients who have
been intubated for a long period of time may have a pharynx that becomes habituated to
stimulation because of the continuous presence of the endotracheal tube. Stimulation of the
carina can be accomplished by suctioning the endotracheal tube and looking for the patient
to cough. In a patient with normal pharyngeal reflex,
you will observe that the patient coughs in response to stimulation of the carina. In
patients with an abnormal pharyngeal reflex, you will observe an absence of coughing in
response to such stimulation. We’ve demonstrated that there are no discernible
brain stem reflexes or responses in this individual. In the presence, then, of these elements of
neurologic examination– that is, no evidence of any cortical or thalamocortical responses
and no evidence of any brain stem reflexes or responses– we can, then, make the determination
that the first examination has shown no meaningful cerebral responses. And we would then repeat
this examination, separated by time. Point of Clarification. Please note that the requirements for time
intervals between exams vary, depending on the age of the patient and on clinical practices
of an individual hospital. You will want to refer to your hospital guidelines for specific
details. Apnea Test. Point of Clarification. The apnea test should only be performed following
the second clinical brain death examination and only if the results of both exams suggest
that the patient has met the criteria for brain death. At this stage, we would now want to do the
apnea test. Under normal circumstances, the child would have had their mechanical ventilation
altered so the carbon dioxide was at around 40 millimeters of mercury. And we would have
pre-oxygenated for at least 10 minutes with 100% oxygen via the ventilator and have a
blood gas to show that our carbon dioxide was around 40 millimeters of mercury. We then proceed to the apnea test. And there
are a couple of ways of doing this. We need to have the child’s chest exposed so that
we can actually see any breathing movements. And then, we want to try and maintain oxygenation
during the procedure. After disconnecting the child from the ventilator,
we can use a T-piece, connected to the ventilator, with at least 10 meters liters per minute
flow through that. When we disconnect the child– using one of these two procedures–,
we’re then going to make sure that the oxygen saturation stays above 85% and that the blood
pressure stays above the fifth percentile for age. And in this child, we’ll take it
to be 75 millimeters of mercury. And we need to observe the child for a period
of five to 10 minutes. And during that time, we would hope that the carbon dioxide would
rise by at least 20 millimeters of mercury. If at any time, the saturation falls below
85 or the blood pressure falls below our predetermined lower limits, we’re going to discontinue the
test, connect the child back up to the ventilator. And we will have to try again some other time. In this instance, let’s just assume that we’ve
not seen any breathing for five to 10 minutes. At the termination of the test, we would take
another blood gas, connect the child up back to the ventilator, and wait for the result
of the gas. If that showed a 20-millimeter rise, and it was above 60 millimeters of mercury,
then we can say that the child has not breathed to that stimulus. Clinical Pearl. Please note brain death should never be diagnosed
at a PaCO2 level less than 60 millimeters mercury, even if the rise in PaCO2 has been
20 millimeters mercury or more. There have been case reports in the literature of children
breathing at higher PaCO2 levels. Therefore, some experts have advocated that the threshold
should be raised even higher than a PaCO2 level of 60 millimeters mercury. You will
need to follow the guidelines set forth in your institution. Please also note that a properly done first
apnea test will virtually guarantee a positive second apnea test because the rise in PaCO2
levels may likely precipitate brain stem herniation, if this has not already occurred in the patient. Ancillary Tests. It’s important to remember that there are
ancillary tests that can be used to assist you in this diagnosis. But they are not essential
nor central elements of the examination or evaluation. These can include an electroencephalogram,
looking for electrocerebral silence, or these can be a PET scan or SPECT scan that might
look for no flow states into the brain itself. That is, the absence of any demonstrable blood
flow. It is important, however, to emphasize that these are ancillary tests and not required
for the central elements of diagnosis
of brain death. That concludes our video on Brain Death Examination. Please help us improve the content by providing
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50 thoughts on ““Brain Death Examination” by David Urion, MD and Robert Tasker, MBBS, MD for OPENPediatrics

  1. hi, thanks a lot for this helpful video/tutorial! except for triple flexion are there any other tests which depend solely on spinal circuitry and not on brain stem function? thanks in advance!

  2. very professional video, all important aspects covered, especially after procedure animation helps to clarify! Great job! thank you

  3. Technical terms used are geared toward individuals in the profession ( i.e. Medical students) but it was nothing an average person with a general biological understanding of the body could not handle. Thank you so much for the video!

  4. There is an error at 14:21 … the eyes turn quickly towards the cold water stimulus, and the cortical reflex elicits the nystagmus response & fast phase away from the stimulus.

  5. This is one of the few company built institutional videos i actually like. Very formal and visually instructional, but never so many details that you loose track of the topic. Good balance.

  6. I hope your video can help me, i need your help my father is on ventilator after asthma attack and today its 8th day he is unconscious but his eye lid is moving from the 1st day, still he is in same condition and now his ventilator has been removed and still he is fighting, now his bp is 109/76 and pulse 15-20
    Can you help me out as soon as possible in this
    Bcz i don't know what to do plz help

  7. Just found out my brother is brain dead a few minutes ago. I don’t really have much experience with this and want to know more about it.

  8. When someone is brain dead, they look the same as when someone is in a deep sleep, deep sleep is the same in my opinion as brain activity is very low, it's at delta waves, heart rate, breathing slows down by alot, we also are cold, there's no consciousness as well, I imagine that no brain functions would mean no afterlife, no consciousness ever again, but I'm not dead, so I don't actually know

  9. Can you do this procedure while a patient is unconscious and has recieved trauma to the head in that moment? Also, what does it mean if the patient only has no pupillary response? Brain bleed? Brain death as well? very good video.

  10. This is what HIPAA laws really do, making every citizen a literal slave to be butchered n murdered alive for cannibals, family cant stop it, same as c0mmunlst chlna. Do you know where adrenochrome comes from?

    Stephanie was butchered alive last month to steal her organs for $5M profit, no pain meds nor general anesthesia allowed, yes she tested positive for feeling pain. She was given zero chance to recover from coma, nor detox from overdose, not even 1 day, before bogus testing for so called brain death, apnea testing is suffocation that causes brain damage. Impossible to have "brain death" from lack of oxygen if heart still beating since heart dies in 5 minutes from lack of oxygen, brain survives over 10 minutes. She was not given naloxone IV to recover from opiate OD, instead ICU gave her IV of deadly fentanyl for several days, which is never prescribed for recovery from OD by opiates, the fatal dose of fentanyl is equivalent to only 2 grains of salt. Her breathing was normal, heartbeat normal, blood pressure normal, jumping around in bed, no trauma, EEG brainwave was normal beta waves for sleep and very active on every channel when I was there with family (see photo), no brain imaging tests, kept sedated and on fentanyl in medically induced coma with temperature reduced so zero chance of waking up from opiate OD no matter if she tried, which also made it impossible to test for socalled "brain death" and easy to fool her family. Her fatal disease was no insurance, hospital losing $10K day in ICU, and her young body worth $5M profit to hospital of rich greedy drs with expensive lifestyles to maintain, decisions decisions. I have friends and coworkers who survived weeks and months in coma, given zero chance of survival by drs, who woke up n recovered to live normal lives. I was in a coma after playing football, thank God i never went to a dr. Her grieving mom in shock was attacked with highpressure lies and fraud to sign bogus contract to murder her mentally ill annoying psychotic troublesome daughter who got out of prison same day as OD, incarcerated 2 years for possessing 10 tobacco cigarettes as a visitor, seeing dead girl walk the halls after hanging herself in cell next door in solitary, it would be a long difficult effort to take care of her in a coma in nursing home, if recovered may be tarded from brain damage, not worth the effort. No need to worry about that bitchy neighbor who hated her daughter enough to call police, same neighbor she argued about with her daughter the night before OD, decisions decisions. Her mom didnt want to talk to me, her mind was made up on day 1, deny all treatment for coma and allowing satanic sociopathic serialkillers to butcher her daughter alive, literally skin her alive and perhaps chop her head off, without pain meds nor anesthesia. Perhaps her daughter would never be allowed to die, just a severed head with awakened brain and empty eye sockets wired in a glass jar perhaps running a computer weapons system in an underground lair at DARPA, or her severed sightless head sewn onto a reanimated corpse by dr frankenstein, or her severed noggin hidden in lockers of unsuspecting college students as a prank at medical school? Once I realized everyone wanted her to die, I attempted petition for emergency conservatorship to give her time to recover and temporary restraining order to halt her murder. A dozen lawyers refused to represent me without $1500 cash in hand plus $750 month and under immediate impossible deadline to fight a medical terminator machine of corporate attorneys. So I attempted a hail Mary pro se petition to the probate chancery court with jurisdiction over conservatorships, Circuit 7 in Davidson county. Both court clerk and Judge Kennedy illegally refused to allow me file pro se, the judge denied both oral and written petitions to save her life from death penalty, the judge lied that friends of a person have no authority as conservator under TN Code, nor to save a life of victim of gangrape and attempted murder to testify whom held her down to forcibly give her the illegal drugs causing OD, allegedly first degree murder, perhaps for life insurance fraud. No police report was filed at ER as required by law, so no rape test for DNA evidence, rape is automatic disqualification from organ harvest due to risk from infection. A police investigation would stop a $5M organ trafficking scam, the victim might wake up and sue them for malpractice, or get them arrested. Its illegal to interfere with a crime scene or obstruct justice, its illegal to murder crime victims, its illegal for a mother to sign a contract to murder her daughter, its illegal for drs and nurses to murder living patients, its illegal to agree to suicide by dr, its illegal to harvest organs from jail inmates who are psychotic with IV drug history and OD. I filed a criminal complaint with Adult Protective Services police against hospital for abuse and murder of disabled comatose patient. I asked police captain and district attorney general to file TRO to stop hospital tampering with and murdering a witness in a rape drugdealing homicide case. But nothing I did was enough to stop this satanic ritual human sacrifice from taking place, not my exorcism on the hospital walls in Jesus name, not the worldwide prayer warrior request on a radio station minutes before her butchering began, ripped apart by power saws, her beating heart ripped out of her chest like a slave on top of an Aztec pyramid scheme in Mexico. At least murdered slaves sometimes got anethesia and pain meds, she got neither. 5 hours of excruciating torture boosted her adrenochrome harvest for vampyre cannibals to get high eating her brain watching her SAW snuff film (perhaps posted on youtube), combined with her premeditated gangrape and OD snuff film by drugdealers, she got Frazzledripped twice in 7 days, yet there was still no police report by Davidson Metro Police, until l made one 10 days later. The first cop said it was impossible so give up, got another 2 cops to do report who said hospital lied on death certificate date, 3rd pair of cops collected more facts names and #s, detective called but still no detective assigned to case. I was blocked from visiting her again by giant cops in her room of grinning nurses, to stop me from caring for her, waking her up and documenting her abuse and neglect, to stop me from stopping their million dollar heist by ritual human sacrifice to Molech in their billion dollar bodysnatcher biz at Skyline Tristar Medical Center in Nashville. The cops stopped my visit in ICU after 5 minutes because drs already signed her death certificate on her living breathing corpse 2 days before cutting out her beating heart, she was their zombie slave, no rights to have visitors talk to her n look into her eyes n say they love her n hold her warm hand, no right to watch her breathe n jump around n watch monitors of her healthy vital signs, no right to see that drs had stopped her iV of fentanyl pain medication and started dialysis, because every dead corpse needs clean blood, living ICU patients dont need clean blood to recover from OD (sarcasm), organ harvest patients never get pain meds nor sedatives, only paralyzing drugs so patients dont jump out of bed n run away, or strangle their drs. I know God always protected her from pain one way or another, by miracles of dissociation and multiple personality disorder, natural opiates in her brain, that she traveled through time to heaven escaping hell on Earth, unless the fact some organs still alive 5 more years traps her in Pergatory Hell. Organs contain parts of brain and thus soul, the largest producer of neurotransmitters is intestines, our gut instinct. Stephanie begged me for weeks to get the day off work to pick her up, I did, then night before she said her mom was driving her back to Knoxville. She asked if I was going to be at her release anyway? I replied no TY I was tired from 16 hours work, then a 12 hour drive n wait to see her for 5 minutes, I'd just see her when she gets home. Ok she promised to cook me a hotdog on the grill. If I had picked her up at jail, or greeted her upon release to see what was going on, she would still be alive, or I would be murdered too. She was so happy to be getting free, us moving in together, give it a try. I miss her telling me she loved me ten times every day, that final day she was pleading nonstop, do you love me? I love you she repeated over and over, like her soul knew something….

  11. Over 1 dozen medical reasons it was illegal to murder Stephanie to steal her organs and transplanting her organs was medical malpractice, gross negligence arrising to homicide of transplant recipients: Rape victim in coma during gangrapes, dementia psychosis hallucinations and delusions in jail entire 6 months before day of coma, long history of IV drug use that caused coma by attempted murder, married to bisexual female in relationship with bisexual males, unsterile piercings, prison tattoos, incarcerated in jail entire 2 years before day of coma, hepatitis patient.
    https://www.forbes.com/sites/quora/2018/12/14/what-factors-disqualify-people-from-being-organ-donors/

    https://youtu.be/EZVo5O0W7VE

    https://youtu.be/ZXFM9INV-bQ

    https://youtu.be/yTuqlIgCu5c

    https://youtu.be/8WpoqaZjoNY

    https://youtu.be/3NQ_EPw73_c

    https://youtu.be/IRzKtRJurRQ

    https://youtu.be/uHDcnpZYivY

    https://youtu.be/rQUlbVI9Ig4

    https://youtu.be/k8rKvpBCV9o

    https://youtu.be/vqNFWYYJjeA

    WTF BS fake news forgets to mention its murder of living person so cannibals can harvest dinner, HIPAA laws now murder you by organ harvest even if your family wants to save your life. "Dead Donor Rule" requires a death certificate before organs can be legally harvested, yet organs can only be harvested by murdering living people, it requires 1 year in coma before "brain death" can be decided for sure, yet comotose patients wake up after 10 years. Illegal aliens are murdered for their organs 10 times more than citizens, darth vader dr says "we should let in more illegal aliens just to steal their organs! We need more death hahaha!"
    https://youtu.be/9oCCkVQeBn4

    Drs arrested for murder during organ harvest
    https://youtu.be/whQVXni1g68

    Dr arrested for murder of 27 patients by OD of fentanyl
    https://youtu.be/QBzMEOYc_68
    https://youtu.be/nloxkyEP9EI

    What organ harvest drs n nurses are
    https://t.co/zaMdk8hOUD

    Dr admits to selling severed heads and beating hearts
    https://www.lifesitenews.com/news/stemexpress-ceo-admits-selling-beating-baby-hearts-intact-baby-heads-in-daleiden-hearing

    Communlst Chlna declares Oplum War on USA by murdering 32,000 American citizens a year with Fentanyl, seizure of 25 tons Fentanyl at Mexican border enough to murder every human on Earth same month Stephanie murdered
    https://m.theepochtimes.com/china-is-using-fentanyl-as-chemical-warfare-) pl qexperts-say_3067392.html

    https://www.campaignlifecoalition.com/brain-death

    Note that my aunt is a neurologist earning $1M year in 1990s when a million dollars was worth something. I asked her how many patients she cured? She laughed and said none, she just takes their money until insurance runs out or they die hahahaha! Now all her kids are drs. The rest of my family are medical malpractice attorneys, 1 is currently chief justice on the state supreme court.

    Drs are officially the #1 cause of death and murder in USA with 2.5M murders per year.
    https://www.lifeextension.com/magazine/2006/8/report_death/Page-01

    Drs supply 100% of pills used in fatal overdose and 95% of methamphetamine which is mostly smuggled through mexico. There was enough fentanyl from Communlst Chlna smuggled through Mexican border in 1 shipment to murder every human on Earth, the Chlnese military's published goal is overthrow of USA.

  12. Doctors like to use the term " death" when a patients brain is not responding to stimuli. This programs the minds of the family to believe their child to be already truly dead. However, the heart is still beating, which does not occur in true death. Why would doctors want the family to believe their child or parent or spouse etc., is dead? Because the organs are harvestable ONLY IF THE DONOR IS STILL ALIVE. Hospitals are in the business of making money and major organs are very profitable. Doctors who do this thing are the worst kind of CRIMINAL!

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