Because the brain stem manages functions the body needs to stay alive that seem to happen automatically -- breathing, body temperature -- both technology and a support team must manage those systems in brain-dead patients.
If a decision is made to try for a live birth, the researchers recommend cardiovascular support, respiratory support, nutritional support, endocrine support, and body temperature regulation.
The mother's body is also at risk of infection, gestational diabetes, and deep vein thrombosis. In all of the cases reviewed, the babies were delivered prematurely via C-section when either the mother or the fetus went into distress. While post-natal followup was only reported for half of the babies, they all were developing typically and "apparently had no problems related to their exceptional intrauterine circumstances," the researchers wrote.
For Jeffrey Spike, a professor of clinical ethics at the McGovern Center for Humanities and Ethics at The University of Texas Health Science Center at Houston Medical School who was involved in the case of a brain-dead pregnant woman in the 1990s, so many unknowns mean it's critical to involve the family in the decision-making.
"There's such a long period to have to keep her stable at very high risk that there's no way I would ever say this is ethically obligatory for anybody," Spike said. "It's perfectly likely that after weeks of being very unstable, they can see she's [in distress], and then decide to do a C-section in the middle of the night in the ICU, and then you have to do a C-section of a woman who's been dead for weeks, and it's a nightmare scenario. It's a huge risk."
Even in the case of the baby of a brain-dead mother who was born alive (according to the family's wishes) and discharged healthy after six weeks in the NICU, Spike says that to decide on the basis of viability alone is wrong.
"I think that the woman's preferences should be respected to the degree they can be known," he said. "Even if she wanted to be pregnant, that doesn't mean she wanted to have a child who would never know her, and she could never love and raise as her own. Allowing a fetal death while inside the womb might be the most peaceful, natural, and ethically appropriate outcome in such tragic circumstances."