Brain death is the irreversible cessation of all brain activity, including the brain and brain stem. The brain dies from lack of blood/oxygenation. Brain death is death.

The doctors have done all they can to treat the patient’s condition. However, the brain will not recover function, and the patient is considered dead. A brain death diagnosis is final and cannot be reversed.

Note: LifeSource does not declare death.

Brain death is unique: Less than 3-4% of all deaths actually meet brain death criteria and declaration. Brain death results from a major injury to the entire brain, such as:

• Stroke
• Head trauma
• Anoxia (lack of oxygen to the brain)
• Central nervous system tumors

If a vented patient is brain dead, LifeSource will arrive at the hospital, clinically manage the patient and further evaluate specific organs. LifeSource will match donated organs to transplant physicians on behalf of their waiting patients, per UNOS policy. When all organs have been placed, LifeSource will arrange for transportation to the donor’s hospital and schedule an OR time. Along with our hospital partners, we will continue to support and educate the donor’s family. Once the surgeons arrive and recovery takes place, organs are transported to waiting recipients. If an organ donor is also a tissue and/or eye donor, those recoveries happen after organ surgery. LifeSource or another partner donation agency then ensures a smooth handover to the funeral home.

Because the patient has died, adequate oxygenation and blood pressure must be maintained. The ventilation of the patient does not stop until midway through recovery surgery. This decreases damage to the organs, thus ensuring better outcomes for recipients. The family will say their goodbyes prior to the transport to the OR and will not see their loved one without the tubes associated with mechanical support.

The doctor will examine the patient carefully and will use several tests to make the diagnosis. He or she will look for three signs:

1. The person is in a coma, and the cause of the coma is known.
2. All brainstem reflexes have permanently stopped.
3. Breathing has permanently stopped. A ventilator must be used to keep the body functioning.

See AAN’s 2010 brain death guideline
See AAP’s 2011 pediatric brain death guideline
See Neurocritical Care Society 2017 Brain Death course

The health care team’s key role is to help the family understand brain death and end of life decisions, and support the family. Families will be provided the amount of time they need to say goodbye to their loved one.

The key role of LifeSource staff is to help the family understand donation opportunities.

Brain death occurs when:

• All brain tissue is dead
• No electrical activity in the brain
• No blood flow

A coma occurs when:

• A portion of the brain is injured
• Electrical activity is present in the brain
• There is blood flow

It can be difficult for families to understand brain death because their loved one looks like they are sleeping and have no outward evidence of death:

• Heart is beating
• Chest is moving
• Patient is warm
• Skin has color
• Continues to be monitored

However, it is important for families to understand that their loved one has died before donation discussions take place. It’s equally important they share the information with other members of the care team.

The following communication points may be useful when helping families understand brain death:

• Provide frequent updates about the patient’s condition throughout their hospitalization.
• Ensure that all hospital staff gives clear and consistent information to the family. It is important for all hospital staff to know what the family has been told about their loved one’s condition.
• After declaration, refer to brain death as death. Tell the family the time of death. The patient is not in a coma. Refer to the ventilator and intravenous medications as artificial or mechanical support. Avoid commonly used euphemisms (passed away, gone, expired) in your conversation about death.
• Encourage the family to ask questions and to share their understanding of their loved one’s death. Allow moments of silence; try not to fill in gaps in conversation with meaningless words or explanations.
  When feasible, allow the family to observe parts of the neurological exams. Explain the medical equipment and its function in the care of their loved one.

Some families may need a visual aid to fully understand the concept of brain death.

Blood Flow

No Blood Flow

The patients will look like they are sleeping when they enter the OR also; ventilator is removed mid-surgery. If you remember one thing, remember that organs are only ever recovered from deceased patients. This is important for you to remember because if you’ve never been involved in a recovery before, it may be unsettling. Brain dead patients also sometimes experience spinal reflexes, which originate from the spinal nerves, not the brain or brainstem. This means that healthcare professionals and families may see some movement of extremities. This should not be confused with brain activity.