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Understanding Brain Death—Commonly Asked Questions
Our hospital provides care for patients with head injuries, a brain tumor, bleeding into the brain or brain infection.
As a result, the physicians, nurses, chaplains, and the patient's family often find themselves in a situation where pain, suffering and loss occur.
Perhaps for the first time in their lives, family members must try to understand and deal with the subject of:
Because this is a new experience for most families, it is helpful to have a clear understanding of what is taking place. Although the following information certainly will not take away your sense of pain and loss, hopefully it will help you and your family better understand what is happening and to make difficult, but necessary decisions.
Q. The medical staff has been very open and honest with us and indicated that our loved one probably will not live. With all the tubes and respiratory equipment, how does the physician determine if a patient has actually died?
A.The physician performs a series of tests to determine if death has occurred. Death is indicated if the patient:
Q. If my loved one is brain dead, what does that mean?
A. When someone is brain dead, it means there is not blood flow or oxygen to their brain and that their brain is no longer functioning in any capacity and never will again. It does not mean that other organs, such as the heart, kidneys or liver, are dead, although they may function for only a few days. Unless damaged by injury or disease, these organs may be used by another individual through an organ transplant.
Q. I have always understood that when an individual dies, the heart stops beating. If my loved one is brain dead, why does the heart continue to beat?
A. The heart has its own pacemaker independent of the brain. As long as it has oxygen, it continues to beat. The heart could actually be removed from the body, placed in a saline solution, given oxygen and still continue to beat. Therefore, the brain can be dead and the heart continue to beat.
Q. What part does medication play in the body of the brain dead patient?
A. In case the family wishes to donate the organs and/or tissues, medications are usually continued until the time the patient is declared brain dead. These medications help keep the blood pressure and heart rate under control, and some reduce swelling in the brain.
Q. Would removing the respiratory support equipment be the same as causing the death of my family member or not giving him or her all possible chances?
A. Once the patient is brain dead, he or she is already dead. The brain will never recover. Since the patient is already dead, you cannot kill him or her by removing respiratory support. The respiratory support equipment only keeps the heart beating, which gives the appearance that your family member is living.
Q. What is the recorded time of death for a brain dead patient...when the patient is declared brain dead or when the heart actually stops beating?
A. The recorded time of death is when the physician actually pronounces the patient dead. The patient can be pronounced dead on the basis of brain death (with the heart still beating). Medically and legally, the patient is dead at that point.
Q. Does the body of a brain dead patient sometimes start to deteriorate even if the patient is still on life support?
A. The failure of many organs begins to occur soon after brain death.
Q. Are there any clinical documented cases where a patient was declared brain dead and later restored to a normal life?
A. No. When you hear about people who were brain dead and recovered, these people were not actually brain dead. They were in a deep coma or vegetative state with slight brain activity.
Q. How can we deal with out struggle between hope and letting go?
A. Sometimes we must accept things we cannot change. When brain death is declared, there is no hope, and it is time to let go. False hope can do a great deal of harm and prevents the grieving process that allows for emotional healing.
Q. We have been told that our loved one is actually dead and there is no longer hope, yet a friend challenges us to "have hope". How do we respond?
A. People often find it difficult to comfort someone in this situation and may often say things which are really not helpful. Some friends mean well, but do not understand the reality of the situation.
Q. Are the hospital staff and organ procurement staff adding insult to injury by suggesting and asking for organ/tissue donation at such a time of tragedy and loss?
A. Organ transplant offers life or a better quality of life to another person. It gives the donor family the opportunity to help others at this time of tragedy and loss.
Q. What organs/tissues can be donated?
A. The heart, liver, lungs, pancreas, kidneys, heart valves, cornea, tissues, bones, skin, tendons and ligaments can be donated.
Q. Would we be told what organs and tissues were used and to whom they were given?
A. BC Transplant sends out a letter to the donor family telling what organs were used. Often recipients will write letters of thanks to the donor families. Names are kept confidential and are not given to the donor or recipient families.
Q. Does the donor's family have to pay for the cost of organ donation?
A. No. The donor's family neither pays for, nor receives payment for organ and tissue donation. All costs related to donation are paid for by the organ procurement program or transplant center. Hospital expenses incurred before the donation of organs and funeral expenses remain the responsibility of the donor's family.
Q. If our family agreed to organ/tissue donation, are we prevented from having a normal funeral?
A. In organ donation, the body is treated with a great deal of respect and dignity. An open casket funeral may be planned and no one, except those directly involved, will know about the donation.
Q. Are there religious objections to organ donations?
A. Most religions throughout the world support organ/tissue donation as a humanitarian act. You are encouraged to discuss this with your own minister, priest, rabbi or hospital chaplain.
Q. Would my family member feel any pain if his or her organs were donated?
A. No, the person is dead and no longer feels pain.
Q. What happens next if we give our permission for the removal of respiratory support equipment, but do not give permission for organ/tissue donation?
A. Respiratory support equipment is removed and your loved one's heart stops beating. The body is sent to the funeral home of your choice. If an autopsy is to be performed, it is done before the body is sent to the funeral home.
Q. What happens next if we give our permission for organ/tissue donation?
A. The family has the opportunity to say their farewells. The organ procurement team evaluates the patient as a donor and blood samples are taken for the matching process. When recipients are located, organs/tissues are removed by a team of surgeons and a specialist trained in organ recovery. The body is prepared for the funeral home of your choice. Donation of organs/tissues should not cause a delay of funeral arrangements.
After reading this and discussing it with your family, you may still have questions. Please talk to your physician, nurse or the hospital chaplain.
For additional
information about organ/tissue donation, please contact:
BC Transplant
1-800-663-6189
Guidelines For the Diagnosis of Brain Death
Brain Death is the irreversible cessation of all brain function including that of the brain stem. There is no possibility of recovery in this situation and once brain death has been confirmed, the patient is legally dead.
The diagnosis of brain death is made by clinical examination according to the criteria on the accompanying for, which is based on "The Guidelines for the Diagnosis of Brain Death" published by the Canadian Congress of Neurological Sciences in 1986. Special tests are not required to make the diagnosis unless the cause of coma is in doubt or there is difficulty completing the clinical tests.
When organ retrieval for the purpose of transplantation is being considered, the BC Human Tissue Gift Act requires that the diagnosis of brain death be made by two physicians independently, neither of who is involved in the organ recovery or in the care of the potential organ recipient. Preferably, one of the two physicians should be either a neurosurgeon or a neurologist. If, however, these specialities are not available, the diagnosis of brain death should be made by licensed medical practicioners representing the highest level of neurological skills available in the institution.
There are no binding time requirements for intitiating testing for brain death for repeat testing. Where the neurological diagnosis is in doubt, testing should be done at least twice, with 12-24 hours between tests, and consideration should be given to using ancillary diagnostic tests. Where a hypoxic'ischemic insult has occurred, at least 24 hours should elapse from the time of injury before brain death is undertaken.
Endorsed
by the Organ Retrieval Subcommittee of BC Transplant.
Potential organ donors must satisfy brain death criteria before they are deemed suitable for donation. Brain death is the irreversible cessation of all brain function including that of the brain stem. There is no possibility of recovery from brain death and once it has been confirmed, the patient is legally dead.
Deceased organ donors are individuals who have suffered irreversible brain death of known etiology, such as:
head injuries
intracranial hemorrhages
hypoxia
primary non-metastasizing brain tumors
The diagnosis of brain death is made by clinical examination according to the criteria on the form at the end of this chapter, which is based on The Guidelines for the Diagnosis of Brain Death published by the Canadian Congress of Neurological Sciences in 1986. Special tests are not required to make the diagnosis unless the cause of coma is in doubt or there is difficulty completing the clinical tests.
When organ retrieval for transplantation is considered, B.C.'s Human Tissue Gift Act requires that the diagnosis of brain death be made by two physicians independently, neither of whom is involved in the organ recovery or in the care of the potential organ recipients. Preferably, one of the two physicians should be either a neurosurgeon or a neurologist. If, however, these specialists are not available, the diagnosis of brain death should be made by licensed medical practitioners representing the highest level of neurological skills available in the institution.
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