Brain death has been accepted worldwide medically and legally as the biological state of death of the organism. Nevertheless, the literature has described persistent problems with this acceptance ever since brain death was described. Many of these problems are not widely known or properly understood by much of the medical community. Here we aim to clarify these issues, based on the two intractable problems in the brain death debates. First, the metaphysical problem: there is no reason that withstands critical scrutiny to believe that BD is the state of biological death of the human organism. Second, the epistemic problem: there is no way currently to diagnose the state of BD, the irreversible loss of all brain functions, using clinical tests and ancillary tests, given potential confounders to testing. We discuss these problems and their main objections and conclude that these problems are intractable in that there has been no acceptable solution offered other than bare assertions of an ‘operational definition’ of death. We present possible ways to move forward that accept both the metaphysical problem - that BD is not biological death of the human organism - and the epistemic problem - that as currently diagnosed, BD is a devastating neurological state where recovery of sentience is very unlikely, but not a confirmed state of irreversible loss of all [critical] brain functions. We argue that the best solution is to abandon the dead donor rule, thus allowing vital organ donation from patients currently diagnosed as BD, assuming appropriate changes are made to the consent process and to laws about killing.

We describe three cases of hair loss in a female pattern hair loss (FPHL) distribution with histologic features of lichen planopilaris (LPP). All patients had a history of diffuse, gradual hair loss in a Christmas tree pattern that clinically presented as FPHL on gross and dermoscopic examination. Notably, there were no characteristic clinical signs of LPP and no histologic features of FPHL. These cases are most consistent with cicatricial pattern hair loss (CPHL). This relatively new entity is similar to fibrosing alopecia in a pattern distribution (FAPD) in that they are both scarring alopecias confined to a FPHL distribution, but CPHL lacks the clinical signs of perifollicular erythema and perifollicular keratosis seen in FAPD. These three cases may present an early, subtle form of CPHL and will be of interest to clinicians and histopathologists alike.

Extracorporeal life support (ECLS) is a high-risk, lifesaving medical treatment that is typically limited to centers that can support a comprehensive ECLS program. Rescue programs can bridge the gap in care between ECLS centers and other tertiary pediatric centers without cardiac surgical and comprehensive ECLS support. We describe how our pediatric center without cardiac surgery successfully partnered with an established ECLS center to develop a Rescue ECLS Cannulation Program. This formalized program provides cannulation and stabilization by a specialized team at the presenting hospital before being transported to a partner hospital. This article outlines how we established our unique Rescue ECLS Cannulation program. We outline the planning, development, and implementation of the program and describe the unique aspects contributing to successful implementation including longitudinal training, staged program evolution, and a bundled approach to care. We also describe the patients who we have cannulated since its inception. Rescue ECLS Cannulation Programs provide access to consistent, highquality, and lifesaving care to critically ill patients at sites without the resources to support a full ECLS program.