Neuro ICU - Do you talk to brain-dead patients?

Dr _______ says we have made more then enough moeny off of you and Brian so we are going to just erase that balance and we will call it even"

Talaxandra.....I believe what you are referring to in this case is organ donation after cardiac death (formerly called non-heartbeating donors). What this is is when a patient is not expected to progress to brain death (as in a case of mine where a man had been shot in the head and while his brain had partially herniated, it could not completely herniate and cause brain death...because of the hole in the head that allowed brain tissue to come out). Anyway, what they do here is take the patient to OR, remove support and if the patient goes asystole within 30 minutes, then organs can be harvested. If not, well then after the person dies, they can still harvest tissues, corneas, etc. usually.

I work a LOT with organ donation in my unit, so if any of you have questions concerning organ donation and how it REALLY works (not some of these misconceptions that have been posted here), PM me and I'll answer questions as best as I can.

Anyway, some of you people are missing the point that brain death is really NO different than being asystole. There is NO coming back from being brain dead....as a matter of fact, once you are declared brain dead, your death certificate is signed because you are DEAD!!! Yes, there is specific criteria that must be met, different tests, so that there is no mistake.

More than 18 years ago as a Resp Therapist I took care of a comatose man, he was a very large man and others were comment about his size ect when we were caring for him. I always talked to him and usually touched his arm or stroked his forehead when I was with him. When he woke up and I mean woke up ( he opened his eyes and just tried to talk he was oriented and alert but on a vent) when I came in to take him off the vent he knew me by my voice. I still to this day get Christmas cards from him and his wife, he told me that I made him feel like a person not a slab of fat (since he heard himself be called that he weighed over 300lbs) and he would never forget me for that reason. I have let that be my reminder when ever I deal with consious and unconsious patients. I have always been proud of myself about this because I was very young 23-24 and working with much older more experianced people who gave me a hard time about this patient and I stuck to my guns Rhonda

I'm sorry if I misrepresented the authors' position in this article, or my own - the point was not that these were case where brain-dead patients became "un-brain-dead" (for want of a less clumsy phrase). Rather it is that determinations of brain death are sometimes made when patients don't fit the criteria. In the cited cases, these reasons may have included inevitable somatic death (or perceived inevitable somatic death), a viable recipient in the wings, or perhaps even financial aspects (this last is not explicit in the text).
I agree with you, NeuroICURN, that these cases describe patients who are not brain-dead - that was the point of the article. The reason I posted it is that, if relatives are told that a patient is brain-dead and s/he isn't, or isn't yet, or is brain damaged, then this muddies the waters for everyone. The term 'brain dead' is thrown around a lot, and as we can see from the discussion thus far, informed and interested health professionals are not always any clearer about it than lay people. For example, on my unit (which incorporates neurosciences), staff refer to patients as being 'brain dead' when they mean unconscious, unresponsive or hypoxically brain damaged, although they know that part of the definition of brain death is that the patient is ventilator-dependant.
About the third case: although van Norman does not specify that the patient had been declared brain dead, she does say: "On the day of anticipated organ collection..." and "Vital organ collection was canceled..." These phrases seem to indicate that organ collection was planned, timed, rather than related to withdrawal of treatment. It is possible, of course, that treatment was planned to be withdrawn that day, with post-mortem organ retrieval, which would seem to be premature. However, as the article is specifically about declaring brain death, I think it's safe to presume that the third patient had been declared brain dead like the other two.

I'm about to begin a Masters research project about ICU nurses talking to brain-dead patients (oh the joys of ethics approval committees!). My interest in this started when I read 'Rethinking life and death' by ethicist Peter Singer - he described observing nurses in ICU talking to brain dead patients as though they were alive, and from that decided they did it because they didn't understand that the patients were clinically dead.
I think that nurses who talk to their brain dead patients do it for a variety of reasons, which may included (but are not limited) to issues about reconciling the apparently living body (sensory knowledge) with knowledge about brain death (intellectual knowledge). I don't work in ICU, though I do work on a nero unit; I always talk to the unconscious, and sometimes talk to patients who have died.
I was at a conference in the UK last year, and an ICU nurse educator said that she not only never talks to brain dead patients, she corrects any students who do. However, one of the anaesthetists there always speaks to his brian dead patients. They're ruining my research!
What do you all think? This isn't something that will make it into my thesis, BTW, but I'm interested in what you think about the project idea, and about your own practice.

Yes I talk to the brain dead patients

but I always talk

I even talk to republican attorneys

is there a difference