Brain Death and Organ Donation

2018 ◽  
Author(s):  
Thomas I. Cochrane
Keyword(s):  
Brain Death ◽  
Organ Donation ◽  
Cardiac Death ◽  
Donation After Cardiac Death ◽  
Donation After Brain Death ◽  
Brain Death Determination ◽  
Brain Dead ◽  
American Academy Of Neurology ◽  
Death Determination

Brain death is the state of irreversible loss of the clinical functions of the brain. A patient must meet strict criteria to be declared brain dead. They must have suffered a known and demonstrably irreversible brain injury and must not have a condition that could render neurologic testing unreliable. If the patient meets these criteria, a formal brain death examination can be performed. The three findings in brain death are coma or unresponsiveness, absence of brainstem reflexes, and apnea. Brain death is closely tied to organ donation, because brain-dead patients represent approximately 90% of deceased donors and thus a large majority of donated organs. This review details a definition and overview of brain death, determination of brain death, and controversy over brain death, as well as the types of organ donation (living donation versus deceased donation), donation after brain death, and donation after cardiac death. A figure presents a comparison of organ donation after brain death and after cardiac death, and a table lists the American Academy of Neurology Criteria for Determination of Brain Death. This review contains 1 highly rendered figure, 3 table, and 20 references.

Brain Death and Organ Donation

2017 ◽  
Author(s):  
Thomas I. Cochrane
Keyword(s):  
Brain Death ◽  
Organ Donation ◽  
Cardiac Death ◽  
Donation After Cardiac Death ◽  
Donation After Brain Death ◽  
Brain Death Determination ◽  
Brain Dead ◽  
American Academy Of Neurology ◽  
Death Determination

Brain death is the state of irreversible loss of the clinical functions of the brain. A patient must meet strict criteria to be declared brain dead. They must have suffered a known and demonstrably irreversible brain injury and must not have a condition that could render neurologic testing unreliable. If the patient meets these criteria, a formal brain death examination can be performed. The three findings in brain death are coma or unresponsiveness, absence of brainstem reflexes, and apnea. Brain death is closely tied to organ donation, because brain-dead patients represent approximately 90% of deceased donors and thus a large majority of donated organs. This review details a definition and overview of brain death, determination of brain death, and controversy over brain death, as well as the types of organ donation (living donation versus deceased donation), donation after brain death, and donation after cardiac death. A figure presents a comparison of organ donation after brain death and after cardiac death, and a table lists the American Academy of Neurology Criteria for Determination of Brain Death. This review contains 1 highly rendered figure, 3 table, and 20 references.

Brain Death, Organ Donation, and Transplantation

2018 ◽  
pp. 276-285
Author(s):  
Hilary H. Wang ◽  
David M. Greer
Keyword(s):  
Brain Death ◽  
Organ Donation ◽  
The United States ◽  
Apnea Test ◽  
Unit Management ◽  
Legal Context ◽  
History Of ◽  
Brain Death Determination ◽  
Brain Dead ◽  
Death Determination

This chapter reviews the history of brain death determination, current guidelines for performing the brain death examination including the apnea test, details of apnea testing, the role of brain dead donors in organ donation, physiologic changes seen in brain dead patients, and the relevant challenges in intensive care unit management of such patients for donor organ optimization. The goal of this chapter is to provide clear guidance for a critical care provider to perform an accurate and thorough brain death examination and to further the reader’s understanding of the historical and legal context surrounding brain death and organ donation in the United States.

scholarly journals An interdisciplinary response to contemporary concerns about brain death determination

Neurology ◽  
2018 ◽  
Vol 90 (9) ◽  
pp. 423-426 ◽  
Author(s):  
Ariane Lewis ◽  
James L. Bernat ◽  
Sandralee Blosser ◽  
Richard J. Bonnie ◽  
Leon G. Epstein ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Brain Death ◽  
American Academy ◽  
Determination Of Death ◽  
Brain Death Determination ◽  
Death By Neurologic Criteria ◽  
Law And Humanities ◽  
American Academy Of Neurology ◽  
Death Determination

In response to a number of recent lawsuits related to brain death determination, the American Academy of Neurology Ethics, Law, and Humanities Committee convened a multisociety quality improvement summit in October 2016 to address, and potentially correct, aspects of brain death determination within the purview of medical practice that may have contributed to these lawsuits. This article, which has been endorsed by multiple societies that are stakeholders in brain death determination, summarizes the discussion at this summit, wherein we (1) reaffirmed the validity of determination of death by neurologic criteria and the use of the American Academy of Neurology practice guideline to determine brain death in adults; (2) discussed the development of systems to ensure that brain death determination is consistent and accurate; (3) reviewed strategies to respond to objections to determination of death by neurologic criteria; and (4) outlined goals to improve public trust in brain death determination.

Organ Donation After Cardiac Death in Children: Acceptance of a Protocol by Multidisciplinary Staff

2012 ◽  
Vol 21 (5) ◽  
pp. 322-327 ◽  
Author(s):  
Allison S. Cowl ◽  
Brian M. Cummings ◽  
Phoebe H. Yager ◽  
Brenda Miller ◽  
Natan Noviski
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Brain Death ◽  
Organ Donation ◽  
Cardiac Death ◽  
Pediatric Intensive Care ◽  
Donation After Cardiac Death ◽  
Staff Members ◽  
Donation After Brain Death ◽  
Multidisciplinary Staff

Background Organ donation after cardiac death is increasingly implemented, with outcomes similar to those of organ donation after brain death. Many hospitals hesitate to implement a protocol for donation after cardiac death because of the potential negative reactions among health care providers. Objectives To determine the acceptance of a protocol for donation after cardiac death among multidisciplinary staff in a pediatric intensive care unit. Methods An anonymous, 15-question, Likert-scale questionnaire (scores 1–5) was used to determine the opinions of staff about donation after brain death and after cardiac death in a pediatric intensive care unit of a tertiary-care university hospital. Results Survey response rate was 67% (n = 60). All physicians, 89% of nurses, and 82% of the remaining staff members stated that they understood the difference between donation after brain death and donation after cardiac death; staff supported both types of donation, at rates of 90% and 85%, respectively. Staff perception was the same for each type of donation (ρ = 0.82; r = 0.92; P < .001). The 20 staff members who provided care directly to patients who were donors after cardiac death considered such donation worthwhile. However, 60% of those providers offered suggestions to improve the established protocol for donation. Conclusions The multidisciplinary staff has accepted organ donation after cardiac death and has fully integrated this kind of donation without reported differences from their acceptance of donation after brain death.

Clinical Problems in Brain Death Determination and Organ Donation

2017 ◽  
Author(s):  
Eelco F.M. Wijdicks
Keyword(s):  
Brain Death ◽  
Organ Donation ◽  
Moral Dilemmas ◽  
Therapeutic Interventions ◽  
Neurological Illness ◽  
Subsequent Discussion ◽  
Brain Death Determination ◽  
Death Determination ◽  
Clinical Problems

There are clear guiding principles in the determination of brain death and subsequent discussion about organ donation. In most situations, brain death is straightforward to diagnose, consent is obtained for organ donation, and—for the endlessly waiting recipients—all goes well. But questions can arise, and occasionally physicians encounter problems. Advances in medical practice have also changed the way physicians approach catastrophic neurological illness, and the consequences of therapeutic interventions must be considered. The number of available ancillary tests also has increased over the years, creating difficulties with interpretation when the validity of the tests is insufficiently known. The diagnosis of brain death also may generate moral dilemmas. This chapter seeks to address solutions to common clinical problems in practice.

Beliefs and Brain Death

2017 ◽  
Author(s):  
Eelco F.M. Wijdicks
Keyword(s):  
United States ◽  
Native American ◽  
Brain Death ◽  
Cultural Diversity ◽  
Organ Donation ◽  
The United States ◽  
Neurological Injury ◽  
Brain Death Determination ◽  
Death Determination

Globalization has increased cultural diversity in many communities. This has immediate implications for care of patients with catastrophic neurological injury and later discussions of brain death and organ donation. While the major religions in the United States—Christianity, Islam, and Judaism—have taken a tolerant position in these matters, some denominations within them are vigorously opposed to it. This chapter presents a range of cultural and religious views of brain death determination and organ donation. In addition to the three major religions, Buddhist and native American views regarding brain death determination as well as organ donation are discussed. Conflict resolution over organ donation is discussed along with the role of clergy in mediating such conflicts between families and medical staff.

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