Introduction:
Brain death creates hopelessness in anybody hearing it; also, it is such a sad thing to hear, right? When somebody is breathing only with oxygen support due to head trauma or conditions associated with the brain, there is a high chance that the person could be brain dead. Unfortunately, it is not a condition from which a person can bounce back to normal. This stage lets the close ones know that they should gear up for the worst.
What Is Brain Death?
Brain death is a condition in which the brain loses its functions due to a lack of oxygen supply. The initial intensive care provided for a person with a severely injured brain focuses primarily on regaining neurological functions; brain death occurs when these treatments do not improve the condition. It is usually assessed based on the neurological response of the patient. Brain death is always a permanent condition as the brain cells lack the potential to regenerate and is typically a sign that declares a person dead.
What Are the Common Causes of Brain Death?
Brain death occurs due to various causes, but the base for every reason is the blockage of oxygen to the brain.
The common causes of brain death include;
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A Serious Head Injury - Damage to the blood vessels in and around the head can block the oxygen supply to the brain, thereby causing brain death.
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Blood Clots or Bleeding in the Brain - Blood clots in the brain's blood vessels or other parts of the body that block the blood from reaching the brain or a brain hemorrhage (bleeding inside the brain) due to leakage from the blood vessels cause brain death.
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Stroke - It is a condition that results from either a blood clot or a brain hemorrhage, also responsible for brain death.
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Heart Attack- A heart attack is when the blood supply to the heart is blocked suddenly. As the heart stops beating, the brain is denied oxygen too. After a while, brain death could occur due to the lack of blood supply.
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Cardiac Arrest - A condition in which the heart stops functioning and can also cause brain death.
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Infections in the Brain - Infections such as encephalitis (inflammation in the brain) and brain abscesses can also cause brain death.
What Needs to Be Considered Before Performing a Brain Death Assessment?
Specific criteria need to be met for a person to be considered for a brain death assessment to ensure that the check is not wrong, which include,
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The patient should have an average body temperature as body temperature variations interrupt the assessment.
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The patient should not be sedated or anesthetized; if so, the tests should be done, particularly after the sedative or the anesthesia wears off.
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Severely low levels of blood sugar, blood pressure, thyroid levels, and electrolytes should be managed before the assessment.
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The patient should not be under any drugs that affect or modify neurological function.
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The patients should not be suffering an inflammation of the brain of any other organ origin.
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There should be a clear view or representation of brain death.
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The patient should be unresponsive and unconscious.
What Specificities Declare a Person Brain Dead?
The analysis of the patient who is under ventilation to be declared brain dead is based on the following criteria;
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The usual responses that a person shows to stimuli are absent.
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The patient shows no response to painful stimuli like a pinch or a prick, which is analyzed in the forehead or nose.
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The pupils of the eye stay put and never respond to light or an object when a torchlight is directed to the eye.
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There is no eye movement, no blinking; the eyes do not follow when an object is moved in front.
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The patient does not respond when something like a tube is inserted into the throat.
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There is no verbal response when questioned.
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Ice water is poured into the ears to trigger eye movement, which comes out negative.
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The patient's breathing and heartbeat are entirely based on ventilation, which, when removed, the breathing stops. It is analyzed by removing the ventilation for a while, even if there is no breathing after ten minutes, and if the brain CO2 (carbon dioxide) shoots up to 20 mm of Hg, then the person fits the brain death criteria. This test is called the single apnoea test.
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There is no response to brain stem stimulation tests as well.
What Are the Criteria for Doctors Who Assess Brain Death?
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Brain death is usually declared by two specialized physicians (usually neurologists or neurosurgeons).
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It is ensured that both the physicians do not belong to the organ transplant or the organ donation team of the particular organization.
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The analysis of brain death is entirely based on clinical response except for two tests performed at last; brain stem reflex and the single apnoea test.
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These tests are usually performed twice to ensure no errors are committed.
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A minimum of a six-hour gap is left before the second test, and the patient is thoroughly monitored in the meantime. When the patient is young, the time limit is extended.
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Also, death is confirmed only when the doctors agree to the lack of patient response.
What Formalities Follow a Brain Death?
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Brain death is mentioned to the close ones to the patient in a carefully polite way, though it is always hard.
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Brain death confirms legal death, and hence the time of death in the death certificate follows the time when the brain death was declared.
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The ventilator needs to be disconnected after consent when brain death is finalized.
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Organ donation is an option for brain-dead patients, but only with consent. Nobody can be forced to do it. Some patients would have willed and provided consent priorly for organ donation; in some cases, the loved ones chose to donate the patient's organs, and the hospital proceeds with further formalities in such cases.
Conclusion:
With the recent advancements in medicine, even after brain death, vital functions in the patient could be maintained for an extended period with a ventilator for the loved ones to sink in. Also, unfortunately, there is no treatment that can make a brain-dead person bounce back. Brain death is always a precursor to declaring the person dead. It could be a hard decision to make while going through a loss; however, organ donation can save lives at risk. Willing and opting for an organ donation are highly appreciable.
