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What Does Brain Dead Mean

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How Is It Decided That An Individual Is Brain Dead

Brain dead: What it is, what it isn’t

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.

Ruling Out Other Conditions

Before testing for brain stem death can begin, doctors must carry out a series of checks to ensure that the symptoms aren’t being caused by other factors, such as:

  • an overdose of illegal drugs, tranquillisers, poisons or other chemical agents
  • an abnormally low body temperature
  • severe under-activity of the thyroid gland

Once these factors have been ruled out, tests are carried out to confirm brain death. The diagnosis of brain death has to be made by two senior doctors. Neither of them can be involved with the hospital’s transplant team.

The doctors will explain the tests to you and they’ll keep you informed about your loved one’s condition at all times.

Examining For Brain Death

The examination for brain death is based on response to external stimuli. Since the brain is the organ that feels outside pain, when the brain is dead the patient feels nothing. Before the examination is performed, the physician will have a toxicology test performed to make sure the patient does not have any muscle relaxants in his system, and will check that the patient’s body temperature is not extremely abnormal, either of which may reduce neurological reflexes.

The positive examination for brain death includes the following:

  • The patient has no response to command, verbal, visual or otherwise.
  • The patient is flaccid, with areflexic extremities. The patient has no movements — the arms and legs are raised and allowed to fall to see if there are adjacent movements, restraint or hesitation in the fall.
  • The pupils are unreactive . The patient’s eyes are opened and a very bright light is shined into the pupil. The light will activate the optic nerve and send a message to the brain. In the normal brain, the brain will send an impulse back to the eye to constrict the pupil. In the non-viable brain, no impulse will be generated. This is performed in both eyes.
  • The patient has no oculocephalic reflex. The patient’s eyes are opened and the head turned from side to side. The active brain will allow a roving motion of the eyes; the non-functional brain will not. The eyes remain fixed.
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    Brain Dead Patients Waking Up

    Although rare, there have been cases of patients who were declared brain dead waking up suddenly, sometimes after spending years in a coma. Colleen Burns was diagnosed by doctors with irreversible brain damage. However, just as she was about to be taken back for her organs to be donated, she woke up on her own. Another woman, Taylor Hale, was in an accident where she fell off the hood of a car. Her doctors told the family there was no way she could come back from that kind of brain damage. However, after some prayer, she woke up. Despite having no memories from before the accident, she lives a normal life.

    Can You Recover From Brain Death

    What Does Brain Dead Mean? Can Any Person Ever Recover ...

    No, a patient who is brain dead will not be able to recover. The body may continue to breathe with mechanical support but eventually, both the breathing and heart will stop even with continued support.

    Being brain dead is not the same as being in a coma or a prolonged vegetative state. The latter two are medical states where one may be unconscious;but still show brain function.

    The media and Hollywood often use these terms interchangeably. But both medically and legally, brain death is its;own distinguishable diagnosis;that one cannot recover from.

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    What Does Brain Dead Mean

    Brain death is when no brain function exists, causing death.

    Brain death;results from “swelling in the;brain where blood flow in the;brain;ceases and;without;blood to oxygenate the cells and the tissue dies” according to Life Source.

    Once brain tissue dies, there is nothing that can be done to heal it.

    When a person deteriorates to brain death, the bodys entire system stops.

    The brain death victim cannot breathe, their heart cannot beat and their body cannot function once the brain dies.

    Brain death is a rare event that occurs in one out of every 200 hospital deaths

    Organ Donation Following Brain Death

    What does brain death mean?What causes brain death?How does a physician determine brain death?I have always understood that when a person dies, the heart stops beating. If my loved one is brain dead, why does their heart continue to beat?Is it possible that our loved one is just in a coma?Does the patient feel any pain or suffer after brain death is declared?Is there anything else that can be done?Are there any proven cases where patients were declared brain dead and later restored to normal life?Are all families approached about the option of organ donation?Why must the ventilator be kept on after a person is declared brain dead?What happens next?Will our religion support our decision about organ and tissue donation?

    LifeShare University is brought to you by;LifeShare Transplant Donor Services of Oklahoma4705 NW Expressway Oklahoma City, OK 73132 840-5551

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    The Patient Shows No Signs Of Recovery

    As we mentioned before, brain death is not the same as a coma, although they may appear the same to someone watching from the outside. USAToday posted an article in 2014 explaining the key differences between brain death, coma, and vegetative state, which seem to be terms used interchangeably.

    As noted before, brain death is the absence of brain activity, with no hope for revival the patient is clinically dead. A coma is an eyes-closed, depressed consciousness from which they cannot be aroused, but there are purposeful brain stem responses and spontaneous breathing. A vegetative state means the patient is alive but has severely impaired consciousness. The eyes may open in the latter condition, but the patient wont be aware of their surroundings. Sources note about 50-percent of patients in a vegetative state wake up after a month, but will often have ongoing impairments.

    Can You Be In A Coma For Years

    What is BRAIN DEATH? What does BRAIN DEATH mean? BRAIN DEATH meaning, definition & explanation

    Usually, a coma does not last more than a few weeks. Sometimes, however, a person stays in a coma for a long time even years and will be able to do very little except breathe on his or her own. Most people do come out of comas. Some of them are able to return to the normal lives they had before they got sick.

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    How Is Brain Death Related To Organ Donation

    In order to be medically able to become an organ donor, an individual must pass away on a ventilator in a hospital. While being brain dead is not the only way this can happen, it is the most frequent condition of those who become organ;donors.

    Only after someone has been declared brain dead, legally dead, the hospital will contact the local organ procurement organization to begin the consideration of donation. Not until this point is it looked up to see if someone is registered as a donor and/or the family is approached to be asked if they would like their loved one to be a donor.

    Once a legal record of donor registration is found and/or a family has consent then the organ donation process will begin. If someone is not a registered donor and the family does not consent the person will not become a donor.

    What Happens After Brain Tissue Dies

    We talk a lot about strokes in a clinical way in medical school. We discuss which areas of the brain are involved, and we correlate the areas damaged with the patients symptoms.

    But what actually happens in the affected brain regions after a stroke? Injuries in the brain dont heal like they do in other organs . Lets take a look at the steps the body takes to heal itself following an ischemic event in the brain.

    There are basically four stages of healing following an infarct, and they usually happen in a predictable timeframe.

    1. The first day After brain tissue dies, it takes a while before you can see any real changes in the cells. The first changes occur in neurons. Somewhere around 12 hours following an infarct, neuronal cytoplasm develops tiny holes and takes on a deep pink-red color . Later the nucleus undergoes pyknosis and karyorrhexis ;Cells in general tend to swell up and become more faded in color. Myelinated fibers disintegrate.

    2. The second day Somewhere around the end of the first day, neutrophils swarm into the area, staying until about the end of the second day, at which point they take off and are replaced by ;macrophages . Microglia become activated too. The tissue begins to undergo liquefactive necrosis from all those nasty enzymes released by the neutrophils. Macrophages are like little moms going around and cleaning up the seemingly never-ending mess. Astrocytes start to react, becoming large and getting ready to divide.

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    The Patient Cant Breathe On Their Own

    One major telltale sign of brain death is that the mechanism in the brain that keeps you breathing when youre not conscious wont kick in. That means to get a diagnosis of brain death, doctors will often see if a patient can breathe unassisted, notes the National Kidney Foundation.

    During the tests to determine brain dead status, the patient is placed on a ventilator and may be given medications to maintain blood pressure and other bodily functions. During the brain death testing, the ventilator and medications continue but they do not affect the results of the testing, it notes.

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  • What Are The Side Effects Of Being In A Coma

    Jahi McMath

    Although many people gradually recover from a coma, others enter a vegetative state or die. Some people who recover from a coma end up with major or minor disabilities. Complications can develop during a coma, including pressure sores, urinary tract infections, blood clots in the legs and other problems..

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    Legal Basis And History Of Brain Death

    The legal definition of death was traditionally viewed as the cessation of cardiopulmonary function.

    As medical advances were made, most notably in the areas of ventilatory support and transplantation medicine, there became an interest in and need for more accurately defining death by neurologic criteria. In 1968, a physician-led committee out of Harvard Medical School published a paper titled A definition of irreversible coma, concluding that patients who meet criteria for a certain type of severe brain injury may be pronounced dead before cardiopulmonary cessation occurs. State legislatures during that time also considered amending their statutes to recognize this changing trend. Kansas became the first state to define brain death as a legal death standard by statute in 1970. Concern soon arose, however, over the lack of consistency in both the legal definition of death used within each statute as well as between those statutes originating among differing states.

    Both New Jersey and New York provide for exceptions from traditional brain death standards in situations of religious belief conflict., The New Jersey statute requires that a physician shall not declare an individual dead on the basis of neurologic criteria when they have reasons to believe that such a declaration would violate the personal religious beliefs of the individual. Instead, when this is the case, death shall be declaredsolely upon the basis of cardio-respiratory criteria.

    Life After Brain Death: Is The Body Still ‘alive’

    ByRachael Rettner03 January 2014

    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.

    Greene-Chandos said Jahi’s case is tragic, and as a mother, she is heartbroken for the family.

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    Responsibilities Of Physicians Determining Brain Death

    The diagnosis of brain death is primarily clinical. No other tests are required if the full clinical examination, including each of two assessments of brain stem reflexes and a single apnoea test, is conclusively performed. In the absence of either complete clinical findings consistent with brain death, or confirmatory tests demonstrating brain death, brain death cannot be diagnosed and certified. These guidelines apply to patients one year of age or older.

    The Patient Is Eligible For Organ Donation

    Is A Brain Dead Person Actually Dead?

    Unlike a coma or vegetative state patient, a doctor may clear a brain dead patient for organ donation , and these patients are in fact are among prime candidates to save others through tissue or organ transplants, notes

    The source explains that in the U.S., most organ donations are from brain dead patients but less than 1-percent of all annual deaths in the country are a result of brain death. Vital organs such as the heart can still be used, as opposed to someone who has died from cardiac arrest where vital organs quickly become unusable for transplantation. However, tissues and bone can still be used up to 24-hours following death in cardiac arrest cases, it adds.

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    Certification Of Brain Death

    Brain death can be certified by a single physician privileged to make brain death determinations. However, before a patient can become an organ donor, New York State law requires that the time of brain death must be certified by the physician who attends the donor at his death and one other physician, neither of whom shall participate in the process of transplantation. This requirement ensures that all evaluations meet accepted medical standards, and that all participants can have confidence that brain death determination has not been influenced by extraneous factors, including the needs of potential organ recipients.

    When two physicians are required to certify the time of death, i.e., when organ donation is planned, both physicians should affirm that the clinical evaluation meets accepted medical standards, and that the data fully support the determination of brain death. Generally, both physicians should observe the patient, review the medical record, and note whether any additional information is required to make a definitive determination. Neither physician should certify brain death unless all aspects of the determination have been completed.

    Medical Record Documentation: All phases of the determination of brain death should be clearly documented in the medical record; The medical record must indicate:

    Brain Death And Organ Donation

    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.

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    An Argument Of Awareness

    Dolan also reports other evidence that Jahi has some degree of not just life but awareness.

    Heart rate variability studies have been done that show that when her mother comes into the room and talks to her, her heart rate goes up, he said.

    He added there are videos from the family that demonstrate Jahi responds to her mothers commands.

    This is in direct response to her mothers voice. These are indications of a sentient being, not just a pound of flesh in a refrigerator, he said.

    Something like that can happen with patients who are brain dead, Magnus responded. Theres still electrical activity going on. Theres still respiration going on. Theres still muscles that are being activated, so all thats still taking place, so all that can still happen.

    But he said its really something people are seeing thats not there.

    Ive been involved in those cases where families just cant understand the concept of brain death, and they dont initially accept that their loved one has passed away or they struggle with that, he said.

    Magnus doesnt see anything wrong with the current criteria for brain death and agrees the definition should remain in the hands of medical specialists.

    However, the medical community isnt fully united on what constitutes brain death.

    One of Dolans experts, Dr. Calixto Machado, Ph.D., of the Institute of Neurology and Neurosurgery in Havana, Cuba, is spearheading a movement to make the whole brain approach the norm for medicine.

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