Sunday, May 27, 2007

All Death is Brain Death

Let that sink in for a moment. When the brain doesn't get oxygen, via the blood, for more than 5-10 minutes, the brain cells die en masse and then necrose. I once read an autopsy report for a person who was an organ donor. (Spoiler alert:this may be considered gross by people who aren't me) By the time the autopsy was started, a few hours after donation took place, the brain was already liquifying. See, it's not a theory. Your brain really dies. It's just that in most cases, the heart stops first, then the brain dies. Brain death, were blood flow to the brain stops due to cerebral edema following trauma or other brain injury, occurs in less than 1% o all deaths.

The heart can be restarted. Think open heart surgery-they actually stop your heart. But without blood flow to the brain, you're toast. Except in rare cases, like cold water drowning, where the brain metabolism is brought almost to a stop.

Remember history class? During the French Revolution when everyone was losing their heads, sometimes the executioner would hold the head up and the eyes or lips would still be moving.

The new debate about the machine began soon after the first few executions. One of the more recognized incidents involved Charlotte Corday. Charged with the death of revolutionary leader Jean-Paul Marat, Corday faced the guillotine on 17 July 1793. After being beheaded, the executioner’s assistant held up her head by the hair, showed it to the crowd, and slapped it across the face. The cheek turned red out of the indignity of the act or so the spectators thought. The scandalous moment upset the crowd and thus gave reason to investigate the matter further. (The Guillotine: A Look into the Machine Built for a Humanitarian Death by Jonas L. Bulman)

Gross. This is why when someone goes into cardiac arrest, you do CPR. Not to keep blood pumping to their heart, but to keep oxygen moving to their brain. Duh, right? If I had a quarter for every doctor who's told me, "But I can't sign the death certificate. Their heart's still beating." Well, I'd have enough to buy a grande latte. Because, of course when someone is going to be an organ donor, they are kept on a ventilator and given various medications to keep the heart pumping and the organs perfused. But their brain flow scan, if they had one, will look like the one above. White=blood flow.

So maybe we need to rethink the whole term "Brain Death". It certainly seems to confuse many, even medical professionals, into thinking it's different from "Real Death". Maybe we should just say they're dead.


PJ Geraghty said...

If I had a mere nickel for every inanity uttered by medical professionals on the topic of brain death, I'd live in a much nicer house.

A problem we have out here (less now than four years ago) is docs who want to declare brain death in a patient who's still breathing, and then get livid with the unfortunate TC who has to explain that no, brain dead people don't breathe, you see, because breathing shows a functioning (if not entirely intact) brain stem, and brain death really includes both the brain and the brain stem. "But it's a fatal injury!" whines the neurosurgeon. Indeed, says the TC, this patient will absolutely die as a result of this injury. But he hasn't died yet, and so I can't move forward with donation after brain death in this case.

Then, of course, I get a call from said neurosurgeon and then have to confirm that yes, this is true, and my TC isn't just trying to be a level-1 PITA. From there, it just goes downhill.

(and yes, I know DCD would be an option. That's a whole 'nother can o' worms.)

TC said...

Yeah, I've had neurons tell me that a pt was brain dead when they were still seizing. Oy.

Jaime said...

hey, im getting ready to start nursing school because i want to become a transplant coordinator, two years ago my sisters was declared brain dead and we donated and the whole process amazed me as much as a fog i was in i still was very much into the organ donation process, so if theres any words of advice anything, i read your blog whenever you update you really helped me make my descion on what i a wanna "be" when i grow up. im 20 years old and just kinda hit me on what i should do with my life the thought of it excites me but i still do not know what to expect. Should i be going to nursing school if i want to follow through with being a transplant coordinator anything you suggest or any words of wisdom will help so much!! thankyou. Jaime

Anonymous said...

Thank you for this blog. I have just accepted a position as a recovery coordinator with Life Center in Ohio. I am nervous, excited and very glad to have your real-life expereince to read about.

TC said...

Wow, Jaime and anonymous, thanks for your kind words. I'm sure you will both be great as TC's. And thanks for proving me wrong about people who post as "anonymous" :) I would love to hear from more TC's and I'd love to hear your experiences. Send them to me and I'll gladly put them on the site.

Anonymous said...

Death is death but it is just different criteria that is used.

Death by neurological criteria or by cardiac criteria but note it is death.

In Australia there are very strict guidelines on who can declare death using neurological criteria but you still get the very occassional person saying that the person is brain dead without applying the criteria.

That is very annoying and potentially very damaging.

I am glad that everybody is outraged about the Dutch reality show. It appears the live donor has an inoperable brain tumour and I am very worried about the potential recipients, has any matching been carried out, and what type of tumour is it?

A very big concern

Denyse - Australia