Faculty Opinions recommendation of Imminent brain death: point of departure for potential heart-beating organ donor recognition.

Organ transplantation is the standard treatment modality for end-stage organ disease in selected cases. Two types of potential organ donors can be identified: the brain-dead 'heart-beating donors', referred to as DBD (donation after brain death), and the warm ischaemic 'non-heart-beating donors', referred to as DCD (donation after circulatory death). Brain death induces several physiological changes in the DBD donor. An autonomic storm is characterized by massive catecholamine release, followed by autonomic depletion during a vasoplegic phase. This is associated with several hormonal changes (suppression of vasopressin, the hypothalamic-pituitary-adrenal axis, and the hypothalamic-pituitary-thyroid axis) and an inflammatory response. These physiological changes form the basis of organ donor management, including cardiovascular stabilization and hormonal therapy (including vasopressin and analogues, thyroid hormone, and cortisol). Donor management is the continuation of critical care, with a shift towards individual organ stabilization. An aggressive approach to maximize organ yield is recommended; however, many treatment strategies need further investigation in large randomized trials. DCD donors have now evolved as a valid alternative to increase the potential donor pool and challenge the clinician with new questions. Optimal donor comfort therapy and end-of-life care are important to minimize the agonal phase. A strict approach towards the determination of death, based on cardiorespiratory criteria, is prerequisite. Novel strategies have been developed, using ex situ organ perfusion as a tool, to evaluate and recondition donor organs. They might become more important in the future to further optimize organ quality.

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Brain Death and Management of the Heart-Beating, Brain-Dead Organ Donor

Handbook of Evidence-Based Critical Care ◽

10.1007/978-3-642-86943-3_54 ◽

2001 ◽

pp. 449-455

Author(s):

Paul Ellis Marik

Keyword(s):

Brain Death ◽

Organ Donor ◽

Heart Beating ◽

Brain Dead

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

Global Journal of Health Science ◽

10.5539/gjhs.v8n7p281 ◽

2015 ◽

Vol 8 (7) ◽

pp. 281 ◽

Cited By ~ 4

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

BACKGROUND: 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.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.METHODS: 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.RESULTS: 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.CONCLUSION: 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.

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Brain Death and Resuscitation of the Organ Donor

10.2310/7ccsp.8029 ◽

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

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Brain Death and Care of the Organ Donor

Essentials of Emergency Medicine ◽

10.5005/jp/books/10275_37 ◽

2003 ◽

pp. 117-117

Author(s):

Shashiraj E ◽

Babu Palatty ◽

Amiya Chakraborty

Keyword(s):

Brain Death ◽

Organ Donor

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Doing What’s Best

Law and ethics in intensive care ◽

10.1093/med/9780198817161.003.0008 ◽

2020 ◽

pp. 163-184

Author(s):

Louise Austin ◽

John Coggon

Keyword(s):

Intensive Care ◽

Health Professionals ◽

Organ Donor ◽

Care Patient ◽

Observation Time ◽

Heart Beat ◽

Best Interests ◽

Medical Law ◽

Legal Certainty ◽

Heart Beating

This chapter explores whether controlled non-heart-beating organ donation (NHBOD) can be in the best interests of an intensive care patient who has expressed a wish to become an organ donor. It begins with an acknowledgment of the concerns health professionals may have about NHBOD before providing an analysis of medical law in the context of decision making and best interests. It concludes that the law’s interpretation of best interests means there will be some situations where NHBOD will be in the best interests of patients in intensive care. It also considers the lack of legal certainty regarding the necessary observation time between the cessation of heart beat and the commencement of organ retrieval.

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Medico-Legal Aspects of Renal Transplantation

Anaesthesia and Intensive Care ◽

10.1177/0310057x8301100406 ◽

1983 ◽

Vol 11 (4) ◽

pp. 345-349

Author(s):

A. G. R. Sheil

Keyword(s):

Renal Transplantation ◽

Public Education ◽

Brain Death ◽

Organ Transplantation ◽

Medical Profession ◽

Public Support ◽

Legal Aspects ◽

Cardiopulmonary Support ◽

Number Of Patients ◽

Heart Beating

Advances in clinical tissue and organ transplantation have enforced changes in legislation concerning the disposal of bodies and their parts. With the evolution of cardiopulmonary support systems came the concept of brain death. To enable physicians to withdraw support without transgressing the law, recognition in law of brain death was necessary. To ensure that the diagnosis of brain death was certain, eminent doctors in advanced communities have drawn up criteria of brain death which are widely recognised and applied with confidence by the medical profession. Organs for transplantation are best obtained from “heart beating cadavers”. Despite public support for organ transplantation the requirements for organs to treat those presenting are not currently being met even though the number of patients who die and who could be suitable donors far exceeds that required. Increased public education to stimulate voluntary donation is necessary. Standardisation of care of comatose patients in hospitals is also required so that brain death may be diagnosed when it occurs. If the procedures for organ donation are familiar and well understood, suitable patients can then become donors according to their own or their relatives’ wishes.

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THE BIOPHILOSOPHICAL BASIS OF WHOLE-BRAIN DEATH

Social Philosophy and Policy ◽

10.1017/s0265052502192132 ◽

2002 ◽

Vol 19 (2) ◽

pp. 324-342 ◽

Cited By ~ 33

Author(s):

James L. Bernat

Keyword(s):

Brain Death ◽

Animal Species ◽

Organ Procurement ◽

Organ Donor ◽

Multiple Organ ◽

Human Organism ◽

Whole Brain ◽

Whole Brain Death ◽

Correct Understanding ◽

Biological Representation

Notwithstanding these wise pronouncements, my project here is to characterize the biological phenomenon of death of the higher animal species, such as vertebrates. My claim is that the formulation of “whole-brain death” provides the most congruent map for our correct understanding of the concept of death. This essay builds upon the foundation my colleagues and I have laid since 1981 to characterize the concept of death and refine when this event occurs. Although our society's well-accepted program of multiple organ procurement for transplantation requires the organ donor first to be dead, the concept of brain death is not merely a social contrivance to permit us to obtain the benefits of organ procurement. Rather, the concept of whole-brain death stands independently as the most accurate biological representation of the demise of the human organism.

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