[gwenith]

WE actually have a legal minefield when it comes to brain death because the only piece of legislation that even mentions it is the transplantation and anatomy act. I have seen life support withdrawn when the patients CPP entered near negative figures and stayed there - it was obvious he was no longer perfusing the brain. Severe incompatable with life head injury unresponsive and ICP >40 - we were not winning that day. I imagine that the criteria will probably vary from state to state across America as it does here.

But apart from the occasional instance quoted above we use the "british criteria" to test for brain death.

[Kyriaka]

It is a very confusing issue.

At what point is there no return. At which point is there no hope?? Sometimes this is very unclear.

My parents were asked if they wanted to donate my organs when I died (which they assumed would happen--the funeral was put on hold for me).

My parents attitude was "you dont know our daughter. She has a strong will and we will give her more time".

Well, here I am. Despite all. I did have a NDE in which I was given a choice to return.

What has scared me is that I wonder if I had had an organ donation card would I be alive today. Would they have tried everything or would I have been "worth" more dead??

There were some hospital personel who were deceptive with the organ donation issue telling my parents that my husband had agreed to organ donation (on another family member--he had not).

[Energizer Bunny]

I'm just a student, but I most certainly can see myself talking to a brain dead patient (or a corpse for that matter) because I talk to everyone all the time and can't stand silence. I also think I would feel the need to show some sort of repect to them by talking to them.

[gwenith]

Originally Posted by Kyriaka

It is a very confusing issue.

At what point is there no return. At which point is there no hope?? Sometimes this is very unclear.

My parents were asked if they wanted to donate my organs when I died (which they assumed would happen--the funeral was put on hold for me).

My parents attitude was "you dont know our daughter. She has a strong will and we will give her more time".

Well, here I am. Despite all. I did have a NDE in which I was given a choice to return.

What has scared me is that I wonder if I had had an organ donation card would I be alive today. Would they have tried everything or would I have been "worth" more dead??

There were some hospital personel who were deceptive with the organ donation issue telling my parents that my husband had agreed to organ donation (on another family member--he had not).

To be an organ donor the patient has to neet certain specific criteria and bleieve me there is no coming back it the patient meets these. Usually the patient also shows other signs such as loss of temperature control, alteration in vital signs and a steady pulse rate that is unvarying etc.

[Kyriaka]

Originally Posted by gwenith

To be an organ donor the patient has to neet certain specific criteria and bleieve me there is no coming back it the patient meets these. Usually the patient also shows other signs such as loss of temperature control, alteration in vital signs and a steady pulse rate that is unvarying etc.

__________________
It is true that you have to meet certain criteria. However, they (the hospital and some of the staff) had already made up thier minds that I would eventually meet those. That was a HUGE assumption.

[stevierae]

Originally Posted by talaxandra

I'm about to begin a Masters research project about ICU nurses talking to brain-dead patients (oh the joys of ethics approval committees!).

Brain dead is DEAD. Period.

I am confused as to why a brain dead patient would even be in an ICU, unless it was just long enough to allow their family to come to grips with their status, make a decision about organ donation, and let go. Yes, those families might find it comforting to "talk to" that loved one, and say their final good-byes, but--why would health care professionals do so? Pray for their souls; yes, please do, but dead people do not hear!

There is a huge difference between talking to a patient in coma or chronic vegetative state than talking to one that is brain-dead. Those people have a chance to "come back," and no one knows what or even if they hear-- but we hope they do, and hope that talking to them will stimulate them and help them "come back" if there is the slimmest chance to do so.

To be brain dead, an EEG has confirmed that there is no longer any electrical activity in the brain. As others have stated, the EEG can be waived--there is other diagnostic criteria, especially in the case of anoxic brain injuries. I know that sometimes just disconnecting from a ventilator for a specified time, to see if any spontaneous breathing will occur in that time, is used. In those cases, an EEG would not tell anyone anything that they do not already know.

However, often organ transplant programs require the EEG to definitively confirm brain death, probably for legal reasons. Also, that EEG report makes it a bit easier for the families to accept that, yes, this loved one REALLY IS DEAD--there will be no coming back. It's at that point that they allow themselves to let go.

The brain controls the autonomic nervous system. If a brain dead person is disconnected from a ventilator, the heart will also stop. All that was keeping that person "alive", or more accurately, his organs perfused, was that ventilator.

[earle58]

Originally Posted by stevierae

Brain dead is DEAD. Period.

I am confused as to why a brain dead patient would even be in an ICU, unless it was just long enough to allow their family to come to grips with their status, make a decision about organ donation, and let go. Yes, those families might find it comforting to "talk to" that loved one, and say their final good-byes, but--why would health care professionals do so? Pray for their souls; yes, please do, but dead people do not hear!

There is a huge difference between talking to a patient in coma or chronic vegetative state than talking to one that is brain-dead. Those people have a chance to "come back," and no one knows what or even if they hear-- but we hope they do, and hope that talking to them will stimulate them and help them "come back" if there is the slimmest chance to do so.

To be brain dead, an EEG has confirmed that there is no longer any electrical activity in the brain. As others have stated, the EEG can be waived--there is other diagnostic criteria, especially in the case of anoxic brain injuries. I know that sometimes just disconnecting from a ventilator for a specified time, to see if any spontaneous breathing will occur in that time, is used. In those cases, an EEG would not tell anyone anything that they do not already know.

However, often organ transplant programs require the EEG to definitively confirm brain death, probably for legal reasons. Also, that EEG report makes it a bit easier for the families to accept that, yes, this loved one REALLY IS DEAD--there will be no coming back. It's at that point that they allow themselves to let go.

The brain controls the autonomic nervous system. If a brain dead person is disconnected from a ventilator, the heart will also stop. All that was keeping that person "alive", or more accurately, his organs perfused, was that ventilator.

there are some of those who continue to talk with the dead; it's a matter of their faith and belief. some believe in absolute nothingness whereas others don't. there's absolutely nothing wrong with talking w/the brain dead.

[stevierae]

Originally Posted by earle58

there are some of those who continue to talk with the dead; it's a matter of their faith and belief. some believe in absolute nothingness whereas others don't. there's absolutely nothing wrong with talking w/the brain dead.

I did not mean to insinuate that it was WRONG. I only meant that it was ineffective--they are dead, and cannot hear. I have certainly stood and prayed, either silently or out loud, when I had brain dead patients in surgery, while preparing for organ donation.

[talaxandra]

Originally Posted by Kyriaka

My parents were asked if they wanted to donate my organs when I died (which they assumed would happen--the funeral was put on hold for me). <snip> What has scared me is that I wonder if I had had an organ donation card would I be alive today. Would they have tried everything or would I have been "worth" more dead??

Originally Posted by gwenith

To be an organ donor the patient has to neet certain specific criteria and bleieve me there is no coming back it the patient meets these. Usually the patient also shows other signs such as loss of temperature control, alteration in vital signs and a steady pulse rate that is unvarying etc.

There's a disturbing article I read by an anaesthetist (Gail van Norman, for those wanting to follow this up ), who described cases where patients did not meet brain death criteria (in all cases had not been appropriately assessed, and in one case was spontaneously breathing) but were in theatre for organ collection - in those cases, an anaesthetist intervened, but I imagine this is not always the case.
My understanding is that the criteria are more consistently applied (ie two assessors, well-separated assessments) in Australia than in the US. However it may just be that Australia under-reports. In any case, while it is perfectly possible that the organ donor liaison staff were a little zealous (or trying to introduce the concept early), I think that Kyriaka is right to be at least cautious, if not downright sceptical about the execution, if not the practice, of diagnosing brain death. Hmm. On re-read, 'execution' was a poor word choice!

For those of you who believe that brain death is equivalent to somatic death (ie that you are just as dead as if your heart had stopped beating for, say, five minutes without intervention), is it your understanding that somatic death will follow? If so, in what kind of time frame?

[Tweety]

Originally Posted by NeuroICURN

Actually Earle, an EEG is NOT a must before removing support. Perhaps in your facility it is, but not in mine.

As Gwenith stated, we're not interested in cortical function. And actually...what's needed to prove brain death is any three of the possible brain death criteria tests. For example, cold calorics, apnea testing, dolls eyes, absence of protective reflexes, blood flow studies, etc.

EEGs are required here prior to donating a persons organs to assure they are truly dead.

However removing life support is a totally different matter. If a patient is in a terminal condition removing life support is an act of courage in my opinion. Here's where living wills come in handy.

At the point life support is removed if they continue to breath, we move them to a private room on a medical unit, so the family can be with them. I always talk to these patients, up until the end.