Erlangen clinicians report tissue damage found by microscopy after a brain was prepared for storage following assisted suicide
Erlangen clinicians report tissue damage found by microscopy after a brain was prepared for storage following assisted suicide
On September 1, authors from University Hospital Erlangen described a single case involving a woman with ALS in an article. After her assisted suicide, her body was cooled, her brain was examined, and the brain was placed in a vitrification solution. Electron microscopy showed identifiable synapses and vesicles, as well as extensive cavity formation within the tissue.
ALS progressively deprives a person of the ability to move and speak. The patient was in her early fifties. The clinic offered her three options: she could decline brain donation, donate tissue for research, or choose structural preservation, which involves long-term storage of the brain in a biobank. She chose storage. The clinicians explained that future technologies might be able to map the structure of a brain preserved in this way.
The patient later arranged her own assisted suicide and asked the physicians whether it could be combined with brain donation and preservation. The clinic had no established procedure. Under the proposed Nectome protocol, preservation must begin within twelve minutes of legal death. In Erlangen, the team first had to determine who could legally release the body and to whom it could be released. Germany had no legally established procedure for postmortem donation of vital organs after circulatory arrest. The parties therefore agreed that this case would involve corneal retrieval, examination of the spinal cord, and an autopsy to remove the brain.
The patient died at home. An independent physician classified the death as unnatural, after which the police and public prosecutor issued preliminary authorization to release the body. The body was taken to the pathology department and cooled to 0 °C within six hours of death. The autopsy began twenty hours after death.
The brain was fixed at 4 °C for two weeks. A small biopsy was then taken from the occipital cortex and examined by electron microscopy. Synapses and vesicles, the small sacs through which nerve cells transmit signals, were identifiable in the images. The neuropil, the network of nerve cell processes and their connections, showed extensive vacuolization, with numerous cavities throughout the tissue.
After the analysis, the brain was placed in a vitrification solution, which prepares tissue for cooling without the formation of ice crystals. Permanent storage at −150 °C was planned. For future cases, the authors propose a Donation-Preservation Pathway. This process would separate the decision to pursue assisted suicide from consent to donation, require an independent assessment, and preserve the patient’s right to withdraw from each stage.
Under the pathway proposed by the authors, consent, independent assessment, and the roles of all participants are defined before death. After death, the team carries out the decisions that were agreed in advance.