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Understanding Brain Death


Most hospitals provide 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:

†Brain death
†The removal of respiratory equipment
†The possibility of organ and tissue donations

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.

The medical staff bas been very open and honest with us and indicated that our loved one probably will not live. With all the tubes and respiratory support equipment, how does the physician determine if a patient has actually died?

The physician performs a series of tests to determine if death has occurred. Death is indicated if the patient:

†cannot breathe without assistance
†has no pupil response to light
†has no response to pain

If my loved one is brain dead, what does that mean?

When someone is brain dead, it means there is no 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.

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?

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.

What part does medication play in the body of the brain dead patient?

In case the family wishes to donate the organs/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.

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?

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.

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?

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.

Does the body of a brain dead patient sometimes start to deteriorate even if the patient is still on respiratory support?

The failure of many organs begins to occur soon after brain death.

Are there any clinically documented cases where a patient was declared brain dead and later restored to a normal life?

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.

How can we deal with our struggle between hope and letting go?

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.

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?

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.

Are all families approached about the option of organ and tissue donations?

Federal law requires that all families of brain dead patients be offered the option of organ and tissue donation.

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?

Organ/tissue transplantation 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.

What organs/tissues can be donated?

The heart, liver, lungs, pancreas, kidneys, heart valves, corneas, tissue, bones, skin, tendons and ligaments can be donated.

Would we be told what organs were used and to whom they were given?

Our local procurement agency sends out a letter to the donor family telling what organs were used, the age and perhaps a little about the person receiving them. 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.

Does the donor’s family have to pay for the cost of organ/tissue donation?

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/tissues and funeral expenses remain the responsibility of the donor’s family.

If our family agreed to organ/tissue donation, are we prevented from having a normal funeral?

In organ/tissue 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.

Are there religious objections to organ/tissue donations?

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.

Would my family member feel any pain if his or her organs were donated?

No, the person is dead and no longer feels pain.

What happens next if we give our permission for the removal of respiratory support, but do not give permission for organ/tissue donation?

Respiratory support 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.

What happens next if we give our permission for organ/tissue donation?

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 pamphlet and discussing it with your family, you may still have questions. Please talk to your physician, nurse, hospital chaplain or the donor coordinator.

For additional information about organ/tissue donation please contact your local organ & tissue procurement agency.

Research for this brochure was done by Chaplain Bob Koerner during a residency in Clinical Pastoral Education at Richland Memorial Hospital in Columbia, South Carolina. Chaplain Koerner is now a staff Chaplain at Saint Vincent Hospital and Health Center, P.O. Box 35200, Billings, Montana

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This material appears on Hepatitis-Central with permission from
Christine Gallagher of Colorado Organ Recovery Systems, Inc.