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Military Offers ‘Closure’ in Brain Deaths

WASHINGTON - Family members of combat troops declared brain-dead will have an opportunity for a final reunion with their loved ones before life support is removed, according to new guidelines provided to battlefield doctors.

The guidelines are aimed at helping doctors determine what to do when a combat casualty suffers brain death, a decision physicians were left to figure out before on a case-by-case basis.

Moving brain-dead troops to more advanced military hospitals, such as those in Europe or the United States, will also make it possible to harvest organs for transplants, the guidelines say.

The recommendations were issued last week by the military's Joint Theater Trauma System, which provides medical research and guidance for battlefield care.

Though the situations are rare, they pose "the most challenging of clinical and ethical management dilemmas" of military medicine, the guidelines say.

"I'm actually surprised that there wasn't one of these (guideline recommendations) sooner," says retired Army colonel John Holcomb, a trauma surgeon who faced cases like these in Iraq in 2006. "It's not easy. There's nothing easy about it."

Since the wars in Iraq and Afghanistan began, about 175 troops with catastrophic head injuries have been evacuated from the war zones only to die later of their wounds, says Army Col. Brian Eastridge, director of the Joint Theater Trauma System. Doctors in combat operations are not required to obtain permission from next of kin before removing a brain-dead patient from life support, Eastridge says.

As a result, battlefield doctors have often struggled with whether to do this, says Air Force Col. Warren Dorlac, former director of trauma care in Iraq and Afghanistan.

Military doctors and officials say family inclusion is essential.

"The guys in the theater, the guys taking care of these patients, realize that it's not only the soldier that's sacrificed here, it's the family," says Dorlac, who helped develop the new guidelines. "We need to treat not just the soldier, but the whole family as well."

That's why, Eastridge says, officials are trying to be "as aggressive as possible to get guys back, even if it's just for closure with their families."

The new guidelines are designed to help military doctors who lack experience in such catastrophic cases, particularly those in which roadside bombs cause devastating wounds, Eastridge says.

Transporting brain-dead troops is not meant to interfere with other medical needs, the guidelines say. If combat doctors are in a mass casualty crisis, they are urged to use medical resources and air evacuation slots for patients who are likely to survive.

Families have told military doctors they appreciate the chance to reunite with their fatally wounded servicemember, Dorlac says. "They've turned to us and said, 'Hey, we appreciate the extra effort that you guys have made to try to get them back here so we can visit with them one more time,' " he says.

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