The concept of Brain Death is often difficult for families and loved ones to come to terms with when dealing with a tragic loss. There are many challenges when diagnosing Brain Death, and also not much recent discussion on the topic. So, what is Brain Death? Brain Death is the complete loss of brain function, this includes involuntary activity necessary to sustain life. The UDDA (Uniform Declaration of Death Act) defines brain death as the “irreversible cessation of all functions of the entire brain”. Although the widespread use of mechanical ventilators and other advanced critical care services have transformed the course of terminal neurological disorders. Vital functions can now be maintained artificially for a long period of time after the brain has ceased to function. There is a need to diagnose brain death with utmost accuracy and urgency because of an increased awareness amongst the masses for an early diagnosis of Brain Death and the requirements of organ retrieval for transplantation. The difference between Brain Death and a vegetative state, which can happen after extensive brain damage, is that it is possible to recover from a vegetative state, but Brain Death is permanent. Someone in a vegetative state still has a functioning brain stem which means: some form of consciousness may exist, breathing unaided is usually possible, and there is a slim chance of recovery because of the brain stem’s core functions may be left unaffected. It is a difficult process to diagnose someone with Brain Death, this includes a battery of tests to be ran – as well as ruling out other conditions such as an overdose, poison, hypothermia, and severe under-activity of the thyroid gland. For a diagnosis of Brain Death to begin, the following criteria must be met: A person must be unconscious and fail to respond to outside stimulation, their heartbeat and breathing can only be maintained using a ventilator, and there must be clear evidence that a serious brain damage has occurred and cannot be cured. For testing Brain death, the following occurs:
- A torch is shone into both eyes to see if they react to the light.
- The eye, which is usually very sensitive, is stroked with a tissue or piece of cotton wool to see if it reacts.
- Pressure is applied to the forehead and the nose is pinched to see if there are any movements in response.
- Ice-cold water is inserted into each ear, which would usually cause the eyes to move.
- A thin plastic tube is placed down the windpipe to see if it provokes gagging or coughing.
- The person is disconnected from the ventilator for a short period of time to see if they make any attempt to breathe on their own.
Brain Death is diagnosed if a person fails to respond to all of these tests. This is a tragic situation for any family to have to endure, but it is under these circumstances the family is asked to understand that their loved on has died, as week as that organ donation can still be presented as an option to give life to others.
Here are some helpful links with how to deal with Brain Death, as well to educate further into the topic:
- https://www.youtube.com/watch?v=rMkUK2NhhjU “Understanding Brain Death” video.