Perspectives toward brain death diagnosis and management of the potential organ donor

2018 ◽  
Vol 26 (6) ◽  
pp. 1886-1896 ◽  
Author(s):  
João Paulo Victorino ◽  
Karina Dal Sasso Mendes ◽  
Úrsula Marcondes Westin ◽  
Jennifer Tatisa Jubileu Magro ◽  
Carlos Alexandre Curylofo Corsi ◽  
...  
Keyword(s):  
Brain Death ◽  
Organ Donor ◽  
Legal Aspects ◽  
Adult Intensive Care Unit ◽  
Potential Organ Donor ◽  
Dead Person ◽  
Brain Death Diagnosis ◽  
Nurses And Physicians ◽  
Brain Dead ◽  
The Brain

Background: Organ donation and transplantation represent one of the most important scientific advances over the last decades. Due to the complexity of these procedures and related ethical–legal aspects, however, there are a lot of doubts and uncertainty about the brain death diagnosis and the maintenance of potential organ donor. Aim: To identify and discuss the different meanings and experiences of registered nurses and physicians from an adult intensive care unit in relation to the diagnosis of brain death and the maintenance of potential organ donors for transplantation purposes. Study Design: Participants were registered nurses and physicians from an adult intensive care unit at a University Hospital from Brazil. Data were collected through semi-structured interviews and analyzed using content analysis. Ethical considerations: This study was approved by the University of São Paulo at Ribeirão Preto College of Nursing Research Ethics Committee. Results: Two main categories emerged from the analysis: (1) brain death diagnosis and its implications and (2) maintenance of the potential organ donor and its repercussion in the donation–transplantation process. Six subcategories were also identified: (1.1) understanding the brain death diagnosis as a tool to aid decision-making; (1.2) diagnosis as guarantee of rights; (1.3) difficulties encountered to establish the diagnosis; (1.4) clinical criteria adopted in Brazil and related ethical–legal aspects; (2.1) specificities of care to the brain dead person and outcomes; and (2.2) nurse’s duties toward the brain dead person. Conclusion: Although the brain death diagnosis is scientifically and legally defined in Brazil and the maintenance of the potential organ donor for transplantation purposes has been addressed during the last years, there are still some doubts about the subject, as its understanding varies according to the personal beliefs, culture, and educational background of individuals, including those who work in this scenario.

Brain Death and Resuscitation of the Organ Donor

2017 ◽  
Author(s):  
Kasra Khatibi ◽  
Chitra Venkatasubramanian
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Brain Death ◽  
Organ Donor ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Potential Organ Donor ◽  
Brain Dead ◽  
Donor After Brain Death ◽  
Apnea Testing

When is a patient brain dead? Under what scenarios in the surgical intensive care unit is brain death a possibility? Who can declare brain death and how? What are the steps after brain death declaration? You will find answers to all of these and more in this review. We will walk you through the principles, prerequisites, and techniques of clinical brain death evaluation using checklists and videos. The role and interpretation of ancillary testing and pitfalls are also discussed. New in this section is a description of the techniques that can be adapted when a patient is on extracorporeal membrane oxygenation. In addition, we have included a section on how to communicate effectively (i.e., what phrases to use) with families while discussing brain death and thereby avoid conflicts. We conclude with a detailed section on the physiology and critical care of the potential organ donor after brain death. This review contains 2 videos, 8 figures, 3 tables and 21 references Key words: Brain death, Apnea testing, ECMO, Organ donation

Physiologic Features of Brain Death

2017 ◽  
Vol 83 (8) ◽  
pp. 850-854 ◽  
Author(s):  
Eno-Obong Essien ◽  
Kristina Fioretti ◽  
Thomas M. Scalea ◽  
Deborah M. Stein
Keyword(s):  
Brain Death ◽  
Injury Severity ◽  
Organ Donor ◽  
Respiratory Dysfunction ◽  
Traumatic Injuries ◽  
Potential Organ Donor ◽  
Major Mechanism ◽  
Patient Demographics ◽  
Widespread Belief ◽  
Brain Dead

Brain death is known to be associated with physiologic derangements but their incidence is poorly described. Knowledge of the changes that occur during brain death is important for management of the potential organ donor. Thus, we sought to characterize the pathophysiology that occurs during brain death in patients with traumatic injuries. All brain-dead patients over a 10-year period were identified from the trauma registry at a level 1 urban trauma center. Patient demographics, injury characteristics, and clinical data for defining organ dysfunction were reviewed for the 24 hours surrounding brain-death declaration. Three hundred and seventy-three patients were identified. Mean age was 37 years (617.2). Seventy-five per cent were male. Major mechanism of injury was blunt trauma in 66 per cent. Median injury severity score was 34 (IQR 25–43) with a median head abbreviated injury scale score of 5. The most common physiological disturbance was hypotension with 91 per cent of subjects requiring vasopressors. Thrombocytopenia and acidosis both had an incidence of 79 per cent. The next most common disturbances were hypothermia and moderate-to-severe respiratory dysfunction in 62 per cent. Myocardial injury was seen in 91 per cent but only 5.7 per cent of patients manifested severe cardiac dysfunction with an ejection fraction of <35. Diabetes insipidus was diagnosed in 50 per cent of patients. Interestingly, coagulopathy was noted in only 61.3 per cent, and hyperglycemia was seen in 36 per cent despite widespread belief that these occur universally during brain death. This is the first and largest study to characterize the incidence of pathophysiological disturbances following brain death in humans. Appropriate management of these dysfunctions is important for support of potential brain-dead organ donors.

Selection of the Brain-Dead Potential Organ Donor

2012 ◽  
pp. 147-154
Author(s):  
Kadiyala V. Ravindra ◽  
Keri E. Lunsford ◽  
Paul C. Kuo
Keyword(s):  
Organ Donor ◽  
Potential Organ Donor ◽  
Brain Dead ◽  
The Brain ◽  
Selection Of

scholarly journals When Life Ceases—Relatives’ Experiences When a Family Member Is Confirmed Brain Dead and Becomes a Potential Organ Donor—A Literature Review

2020 ◽  
Vol 6 ◽  
pp. 237796082092203
Author(s):  
Birgitta Kerstis ◽  
Margareta Widarsson
Keyword(s):  
Literature Review ◽  
Brain Death ◽  
Family Member ◽  
Healthcare Professionals ◽  
Organ Donor ◽  
Essential Information ◽  
Potential Organ Donor ◽  
Donation Process ◽  
Brain Dead ◽  
Meta Analyses

Introduction Most healthcare professionals rarely experience situations of a request for organ donation being made to the patient’s family and need to have knowledge and understanding of the relatives’ experiences. Objective To describe relatives’ experiences when a family member is confirmed brain dead and becomes a potential organ donor. Methods A literature review and a thematic data analysis were undertaken, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting process. A total of 18 papers, 15 qualitative and 3 quantitative, published from 2010 to 2019, were included. The electronic search was carried out in January 2019. Results The overarching theme When life ceases emerged as a description of relatives’ experiences during the donation process, including five subthemes: cognitive dissonance and becoming overwhelmed with emotions, interacting with healthcare professionals, being in a complex decision-making process, the need for proximity and privacy, and feeling hope for the future. The relatives had different needs during the donation process. They were often in shock when the declaration of brain death was presented, and the donation request was made, which affected their ability to assimilate and understand information. They had difficulty understanding the concept of brain death. The healthcare professionals caring for the patient had an impact on how the relatives felt after the donation process. Furthermore, relatives needed follow-up to process their loss. Conclusion Caring science with an explicit relative perspective during the donor process is limited. The grief process is individual for every relative, as the donation process affects relatives’ processing of their loss. We assert that intensive care unit nurses should be included when essential information is given, as they often work closest to the patient and her or his family. Furthermore, the relatives need to be followed up afterwards, in order to have questions answered and to process the grief, together with healthcare professionals who have insight into the hospital stay and the donation process.

Hormonal Therapy to the Brain-Dead Potential Organ Donor: The Misnomer of the “Papworth Cocktail”

2008 ◽  
Vol 86 (10) ◽  
pp. 1479 ◽  
Author(s):  
Dimitri Novitzky ◽  
David K.C. Cooper ◽  
Winston Wicomb
Keyword(s):  
Hormonal Therapy ◽  
Organ Donor ◽  
Potential Organ Donor ◽  
Brain Dead ◽  
The Brain

scholarly journals Lived Experiences of Iranian Nurses Caring for Brain Death Organ Donor Patients: Caring as “Halo of Ambiguity and Doubt”

2015 ◽  
Vol 8 (7) ◽  
pp. 281 ◽  
Author(s):  
Zahra Keshtkaran ◽  
Farkhondeh Sharif ◽  
Elham Navab ◽  
Sakineh Gholamzadeh
Keyword(s):  
Brain Death ◽  
Thematic Analysis ◽  
Lived Experiences ◽  
Organ Donor ◽  
Organ Donors ◽  
Structured Interviews ◽  
Supportive Services ◽  
Care Giving ◽  
The Given ◽  
The Brain

<p><strong>BACKGROUND: </strong>Brain death is a concept in which its criteria have been expressed as documentations in Harvard Committee of Brain Death. The various perceptions of caregiver nurses for brain death patients may have effect on the chance of converting potential donors into actual organ donors.</p><p>Objective: The present study has been conducted in order to perceive the experiences of nurses in care-giving to the brain death of organ donor patients.</p><p><strong>METHODS:</strong> This qualitative study was carried out by means of Heidegger’s hermeneutic phenomenology. Eight nurses who have been working in ICU were interviewed. The semi-structured interviews were recorded bya tape-recorder and the given texts were transcribed and the analyses were done by Van-Mannen methodology and (thematic) analysis.</p><p><strong>RESULTS: </strong>One of the foremost themes extracted from this study included ‘Halo of ambiguity and doubt’ that comprised of two sub-themes of ‘having unreasonable hope’ and ‘Conservative acceptance of brain death’. The unreasonable hope included lack of trust (uncertainty) in diagnosis and verification of brain death, passing through denial wall, and avoidance from explicit and direct disclosure of brain death in patients’ family. In this investigation, the nurses were involved in a type of ambiguity and doubt in care-giving to the potentially brain death of organ donor patients, which were also evident in their interaction with patients’ family and for this reason, they did not definitely announce the brain death and so far they hoped for treatment of the given patient. Such confusion and hesitance both caused annoyance of nurses and strengthening the denial of patients’ family to be exposed to death.</p><p><strong>CONCLUSION:</strong> The results of this study reveal the fundamental perceived care-giving of brain death in organ donor patients and led to developing some strategies to improve care-giving and achievement in donation of the given organ and necessity for presentation of educational and supportive services for nurses might become more evident than ever.</p>

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