Discussion Post-Brain Death
Your patient is a 23-year-old female with a history of headaches. This morning she was experiencing a really bad headache as her boyfriend was driving her to the university. He thought she was sleeping and by the time they got to the school, 45 minutes later, she was not waking up. She was diagnosed with a cerebral aneurysm and you are taking care of her in the Neurological ICU.
What testing do you expect to be performed to diagnose brain death?
What is the procedure when a patient is determined to be brain dead?
Who should approach the family about organ donation?
The family is approached about organ donation. The patient indicated on her driver’s license that she wanted to be an organ donor. Her mother refuses to consent for organ donation.
Do you think donation should happen anyway? Why or why not?
What will be the ethical consequences of your decision?
Sample Answer
Diagnosing Brain Death and Navigating the Organ Donation Dilemma
Diagnosing Brain Death:
Several tests are performed to confirm brain death in your patient:
- Brain stem evaluation: Checking for brainstem reflexes like pupillary responses, corneal reflex, and oculocephalic reflex (doll’s eye movement).
- Apnea test: Assessing spontaneous breathing after stopping respiratory support for a specific period.
- Electroencephalogram (EEG): Evaluating brain activity for complete absence of electrical signals.
- Confirmatory tests: In some cases, additional tests like cerebral angiography or nuclear medicine studies might be used.
Determining Brain Death:
Brain death is diagnosed when two independent neurological examinations, separated by a set time interval, confirm irreversible cessation of all brainstem functions. The specific guidelines and procedures for declaring brain death may vary by region and institution.