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Can Someone Recover From Being Brain Dead

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Brain Death And Organ Donation

Is A Brain Dead Person Actually Dead?

In some cases, a person who is brain dead may be a candidate for organ donation. If the person was a registered organ donor, or if their family knew of their wish to be an organ donor, their death is declared, but the ventilator is left on. Drugs that help preserve the internal organs are still given. The dead person then undergoes an operation to remove viable organs such as kidneys. After the operation is complete, the ventilator is switched off. Funeral arrangements can then be made by the family.

Problems With The Apnea Test

According to the published guidelines, the apnea test is the cornerstone procedure for declaring a patient brain-dead. This procedure, just like all the other clinical test-criteria put forth by the Harvard Committee, has never been validated. A recent review of current-practice apnea testing reveals that it still lacks consensus standardization regarding the actual procedure, monitored parameters, and evidence-based safety measures that may be used to prevent complications . A close look at the apnea test in light of the neuro-intensive care requirements for SBI demonstrates that this procedure does not take into account the pathophysiology of brain injury and coma, namely those factors which can worsen cerebral ischemia, brain edema, and cerebral hypertension .

In the apnea test, the patient is disconnected from the ventilator to let the PaCO2 rise above a certain threshold or at least 20 mmHg above the baseline, while oxygenation is preserved via a catheter down the endotracheal tube delivering 100 percent O2 . Given the above information regarding the effect of CO2, the harmful effect of the apnea test, which induces hypercarbia in comatose patients with SBI is self-evident. The apnea-induced hypercarbia can easily push CBF to below the critical level of 1015ml/100g/min, below which cellular membrane depolarization and disruption of ionic homeostasis occur .

What Is Brain Death

Brain death is when the brain has been so badly damaged that it completely and permanently stops functioning. This can happen after a severe head injury, bleeding in the brain from a stroke or a haemorrhage, an infection in the brain or a lack of oxygen to the brain.

Just like any other part of the body, when the brain is injured, it swells. Because the brain is encased in the skull, which is rigid, this swelling can result in an increase in pressure. The swelling and pressure might become so severe that blood flow to the brain is blocked, which causes further damage to the brain.

Brain cells are very sensitive to a lack of blood and oxygen. Without these, the brain cells die. When this happens, the brain stops performing vital functions such as the controlling breathing, controlling the heart rate, keeping blood pressure up and keeping body temperature up. These are all necessary for life.

Since brain cells cannot grow or recover, brain death is irreversible.

Under Australian law, brain death is one of two situations in which a person can be certified dead. The other is circulatory death, which is when a persons heart stops functioning.

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How Is Brain Death Confirmed

Before brain death can be confirmed, the following is required.

  • There must be sufficient evidence of severe brain injury.
  • It must be certain that the persons condition is not due to sedative drugs.
  • It must be clear that there is no other reversible cause of the persons condition.
  • Two senior doctors must perform separate tests at the bedside to determine whether the brain is working or not. These doctors check to see if the cranial nerves that pass through the brain stem and control all vital reflexes are working.

    They also check to see if the person:

    • has any response to pain
    • has any response when a light is shone in the pupil of each eye
    • blinks or moves when each eye is touched
    • responds to ice cold water put into the ear canal
    • has a cough or gag reaction when the back of the throat is touched
    • can breathe when disconnected from the ventilator.

    For a person to be certified brain dead, they must show no response to every one of these tests.

    In some cases, not all of these tests can be done, such as when there are extensive facial injuries. In such cases, radiological imaging is done to check if there is any blood flow to the brain.

    The patients time of death will be recorded as the time that brain death was confirmed.

    How Can Doctors Tell If Someone Is Brain Dead

    Understanding Brain Death « Finger Lakes Donor Recovery ...

    Doctors first make sure the person doesn’t have a medical problem that causes a deep coma similar to brain death. Such problems include:

    • Overdose of certain kinds of drugs

    If the person doesn’t have one of those problems, doctors do a physical exam to look for signs of brain activity including:

    • Trying to breathe if the ventilator is turned off

    • Flinching or moving if the person is pinched or poked by a needle

    • Gagging on something put in the back of the throat

    • Blinking if something touches an eyeball

    • Pupils narrowing in response to a flashlight

    If there’s no sign of brain activity, doctors sometimes test again 6 to 24 hours later to make sure the person again shows no response. After testing twice with no response, doctors know that the person is brain dead.

    Instead of waiting a day to repeat the examination, doctors may do:

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    How Long Will A Brain

    A 13-year-old girl in California continues to be on a ventilator after being declared brain-dead by doctors. Although a brain-dead person is not legally alive, how much of the body will keep on working with the help of technology, and for how long?

    Jahi McMath of Oakland, Calif., was declared brain-dead last month after experiencing an extremely rare complication from tonsil surgery. Jahi’s family members have fought to keep their daughter on a ventilator, but a judge has ordered that the machine be turned off next week.

    A person is considered brain-dead when he or she no longer has any neurological activity in the brain or brain stem meaning no electrical impulses are being sent between brain cells. Doctors perform a number of tests to determine whether someone is brain-dead, one of which checks whether the individual can initiate his or her own breath, a very primitive reflex carried out by the brain stem, said Dr. Diana Greene-Chandos, an assistant professor of neurological surgery and neurology at Ohio State University Wexner Medical Center. “It’s the last thing to go,” Greene-Chandos said.

    In the United States and many other countries, a person is legally dead if he or she permanently loses all brain activity or all breathing and circulatory functions. In Jahi’s case, three doctors have concluded that she is brain-dead.

    With just a ventilator, some biological processes including kidney and gastric functions can continue for about a week, Greene-Chandos said.

    What Does It Mean To Be Brain Dead

    “It’s complicated,” Lewis Nelson, MD, the chair of emergency medicine at Rutgers New Jersey Medical School, tells Health. There are two major parts of the brain, he explains: The cortex, which is the part that helps you think, and the brain stem, which controls things like your breathing.

    When someone is brain dead, “both your cortex and brain stem have deactivatedthey’re not functional,” Dr. Nelson says.

    A person’s heart will continue to beat when they’re brain dead and receiving medical careprovided they’re put on a ventilator to restore their breathing, which is what typically happens, Dr. Nelson says. “But if someone is brain dead and you turn off the ventilator, they will die,” he says.

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    Can Dead Brains Be Brought Back To Life First Human Study To Find Out

    Last month, a Philadelphia-based biotech company kicked off a clinical trial that pushes the envelope of what it means to be dead.

    Armed with ethical approval from the IRB at the Anupam Hospital in India, Bioquark is recruiting 20 patients who have been clinically deemed brain dead from severe traumatic brain injury.

    With an arsenal of cutting-edge, if mysterious, treatment techniques stem cells, bioactive molecules, brain and spinal cord stimulation the team hopes to revive parts of the patients basic brain functions, with the eventual holy grail goal of returning the ability to breathe on their own.

    The anticipated deadline for measurable results? A short 15 days.

    Let that sink in.

    If your first reaction is incredulity, youre not alone. What is this, The Lazarus Effect, Frankenstein, The Walking Dead? Some sort of viral campaign for an upcoming horror flick?

    Not quite. A horde of zombies may not be in our future, but Bioquarks goals are to cheat death. Heres what the stunningly ambitious ReAnima project plans to do.

    The Tricky Business of Defining Death

    We often think of death as flipping a switch: one minute youre there, the next minute its all lights go out.

    Brain death, in contrast, is final. The diagnosis signals a complete and irreversible destruction of the brain, including the brain stem. Brain dead individuals arent comatose or in a vegetative state. They have no hope for spontaneous recovery. Theyre dead.

    The Lazarus Toolkit

    ReAnimation

    Things To Look For When Considering A Setting To Care For Your Loved One:

    ‘Miracle Man’ continues recovery after being nearly brain-dead

    Here are some things to look for when choosing a place for care:

    • Your family members current treatment team has received good feedback about the programs quality of care when they have referred others there.
    • The staff make you feel comfortable. They are available to talk about your concerns, and they answer your questions.
    • The program has a multidisciplinary treatment team that, at a minimum, includes a rehabilitation physician, nurse, speech pathologist, physical therapist, occupational therapist, psychologist, and social worker.
    • The treatment team meets together to identify treatment goals and review progress.
    • The program and treatment staff have worked with the same kinds of problems that your family member has.
    • The facility knows about the specific care your loved one needs and can meet those needs. You can help to make sure that a detailed nursing care plan is created.
    • The program includes case management to help plan for the next level of care, whether its moving to a rehabilitation program, an LTACH, a SNF, or home.
    • The program provides education and training for future caregivers.
    • The program has a systematic approach to measure progress in all patients.
    • The program is guided by recommendations for rehab programs from the American Congress of Rehabilitation Medicine and the NIDILRRs Traumatic Brain Injury Model System.
    • The program receives good grades in state and/or federal quality ratings

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    How Is It Decided That An Individual Is Brain Dead

    A doctor will do tests to make a diagnosis of brain death. These tests are based on sound and legally accepted medical guidelines. Tests include a clinical examination to show that an individual has no brain reflexes and cannot breathe on his or her own. In some situations, other tests may be needed. You can ask your doctor to explain or show you how brain death was determined for your loved one.

    Possibly, an individual may show spinal activity or reflexes such as twitching or muscle contractions. Spinal reflexes are caused by electrical impulses that remain in the spinal column. These reflexes may happen even though the brain is dead.

    Comparison Of Coma Vegetative State And Minimally Conscious State

    Inconsistent

    As with the VS and MCS, how fast people recover and how much they recover from the confusional state may vary. Most people who reach the confusional state make further progress. The severity of their brain injury and related health problems determine the degree of recovery. The less time the person is in the confusional state, the better their recovery will be. Mild problems such as poor sleep or urinary tract infections may lengthen the confusional state, but they may not affect the outcome.

    Once the confusional state ends, people can usually pay attention, keep track of place and time, and hold onto memories of daily experiences again. They will likely still have serious cognitive problems such as impaired attention or memory or slowed thinking. These problems are likely to get better over time. While some people make limited progress, others make a good deal of progress.

    This image shows patterns of recovery that may follow coma. Some people wake up quickly from coma they may briefly stay in the MCS before further recovery. They may also have mild impairments. Others may be in the MCS for a long time after emerging from the VS. They usually have more long-term impairment. Slow recovery may continue for several years, especially for those with traumatic injuries. Sometimes, people stay in the VS or MCS for a long time. In some cases, these conditions may be permanent.

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    Transitions To Different Levels Of Care

    During recovery, people in the VS or the MCS may get care in many settings. A person with a DOC will likely start treatment in an acute care hospital the focus is on saving the patients life and stabilizing the patient. Once those needs are met, the focus moves to restoring as much function as possible. Sometimes this takes place in an acute rehabilitation hospital. These hospitals provide high-intensity, team-oriented services. Services include physical therapy, occupational therapy, speech-language therapy, recreational therapy, neuropsychological services, and medical and nursing care.

    Some patients dont go from the acute care hospital to an acute rehab program. These patients may go directly to a long-term acute care hospital , a skilled nursing facility , a subacute rehab program, or a nursing home. They may also go home with family or have home health care or outpatient treatment. People who get care in an acute rehab program first are usually discharged to one of these places as well.

    When patients are medically unstable or dont show signs of recovery for a long time, doctors may consider palliative care. In this type of care, the focus of treatment shifts from recovery to comfort.

    Many factors affect where a person with severe DOC or other severe impairments goes after leaving an acute care hospital or rehab program. These factors include:

    New Scanners To Detect Awareness

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    Researchers at Cambridge are developing new tests and scanners to detect brain activity. Using familiar stimuli, the scanners determine whether the individual is responding to heat, cold, touch, sound, photographs, etc. The scanners then determine whether there are fluctuations within the brain that signal recognition of the stimulus. When physicians review these fMRI scans and determine a patient is aware, they can alter the treatment and care regimen in such a way that it can help the individual recover from their injuries.

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    What Happens After Brain Death Is Confirmed

    Once someone has been confirmed as brain dead, and before anything else is done, the ICU doctor will meet with their immediate family to explain the situation and decide when the ventilator should be switched off and the heart allowed to stop.

    If the person who has died is able to donate their organs and tissue, the doctor will discuss with the family the possibility of donation. If the family agrees to donation, the patient will be kept in the ICU connected to the ventilator receiving care for another 12 – 24 hours. If the family decides to stop the ventilator, and/or decides not to donate their loved ones organs and tissue, the ICU staff will help guide them through this process.

    Every attempt will be made to cater to the wishes of each individual family, keeping in mind that once someone is brain dead, their heart may stop even before the ventilator is turned off.

    Social workers, pastoral care workers and ministers of religion are available to help the family during this difficult time.

    Was It Really Brain Death

    Twenty-one-year-old Zack Dunlap from Oklahoma appeared on NBC’s Today Show in 2008 to tell an incredible story of hearing a physician telling his parents that a PET scan confirmed that he was brain dead after a catastrophic brain injury. While he was being prepared for organ donation, however, he moved his arm purposely in response to stimuli. Dunlap recovered, went to a rehabilitation hospital, and ultimately went home 48 days later, very much alive.

    Earlier this year, 13-year-old Trenton McKinley from Alabama and his parents hit the media circuit to talk about the miracle of Trenton awakening after being declared brain dead from a vehicle accident1 day before his organs were scheduled to be harvested.

    The likely explanation for such “recoveries” from brain death, according to experts, is that these individuals were never brain dead in the first place. “Errors have been made where people declared brain dead were later found to have spontaneous movement that should not have been possible,” says Robert M. Sade, MD, professor of surgery and director of the Institute of Human Values in Health Care at the Medical University of South Carolina in Charleston. “In virtually all those cases, brain-death determination was not done correctly. If you don’t go through the exact protocol for brain-death determination, you’re likely to have patients diagnosed as being dead by neurologic criteria who are, in fact, not brain dead.”

    • Was It Really Brain Death?

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    Taking Care Of Yourself And Other Family Members

    Family members of a person in the VS or the MCS often feel a sense of loss or grief for the relationship they had before the injury. You can cope with these feelings in a few ways. A person in the VS or the MCS may make slow progress or go for long periods with no progress. Keeping a journal of the changes you have seen may be comforting. This may let you see how your loved one is more able to respond than he or she was at an earlier point in time.

    Having a loved one who is in the VS or the MCS can be physically and emotionally draining. Dealing with this alone can be too much for one person. Its important to rely on support from others. You can look to existing supports, such as family, friends, and religious groups. You can also find new supports.

    Other resources to consider include support groups and agencies, and the internet. You can contact the Brain Injury Association of Americas National Brain Injury Information Center . The BIAA can give you contact information for the closest chapter of your state brain injury association. Health care providers such as doctors, therapists, and social workers may also be good sources of information about supports available to you

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