One issue related to organ donation that is often misunderstood is the concept of brain death. Many people do not realize that to donate organs a person must be “brain dead”. Most people are more familiar with the concept of “cardiac death”, which means that the heart stops functioning. With brain death, the brain stops functioning.
Brain death is death. It is the cessation of all brain function, meaning that the patient is unable to breathe spontaneously and has no memory, consciousness, knowledge, thought, feeling, sight, touch or any other sense. It is permanent, irreversible, and not the same as being in a coma or vegetative state. The brain is irreparably destroyed.
The criteria for determining brain death were first established in 1968 by a group of Harvard Medical School specialists. These criteria have been refined with experience, endorsed by the American Medical Association, medical ethicists, the government and accepted by all major religions in the country.
Before the development of life-support machinery, such as the ventilator and the respirator, anyone in this condition suffered cardiac arrest very quickly because the lack of oxygen to the body caused the heart to stop beating. Now, however, the definition of death is more complex. With life-support equipment, a patient can receive oxygen and the vital organs can “function” for some time even after the brain has died. The time can vary from a couple of hours to a couple of days.
Brain death usually occurs when a person receives a severe head injury or suffers a stroke or a burst blood vessel (aneurism) in the brain. When an unconscious patient who has suffered such an injury is first brought to the hospital, he or she is connected to a ventilator immediately as a life-saving measure. Only later, after the patient is stabilized, is it possible to determine the condition of the brain.
Following specific guidelines, the physician taking care of the patient in the intensive care unit orders certain tests to determine if there is any brain function. If the results indicate that no function remains, the patient is brain dead. The person will probably look as if he or she is only asleep and able to awaken at any moment. But in fact, the personal, intellectual and social characteristics that made that person an individual are gone. Without the ventilator, the person would make no effort to breathe and the heart would soon stop.
It is at this point that the physician explains the patient’s status to the family. Also, because time is limited, if the patient's organs are suitable for donation, the family is informed of the option for organ donation. If the patient has registered their intent to donate their organs and/or tissue as a gift of life for another individual, the family will be presented with an appropriate statement of intent.
For the organs to be successfully used to save the lives of others, they must be removed as soon as possible. If the family members agree to donate their relative’s organs, the ventilator that has supplied oxygen to the patient all along remains on to keep blood flowing to the organs. This is a concept that many people find hard to understand, but it is the key to organ donation. If the family decides not to donate, the ventilator is discontinued.
Although the definition of brain death has gained legal, ethical and religious acceptance, it has posed new problems for health care professionals and ethicists. The question becomes, how and when do you recognize the moment of death of the brain dead patient? For most people it is important to have a definitive ending when a loved one dies in a hospital, to visit the bedside of that person to pay last respects.
Organs can only be used for transplant if they are oxygenated and functioning up until the moment they are removed from the donor. This is why donated organs must come from a person who is brain dead and whose organ function has been maintained artificially. Otherwise, the organs are not useful for transplant. This isn’t the case for tissue donation. Tissues don’t require the continuous supply of blood and oxygen like organs do, so tissue donation can take place after a cardiac death, as well as brain death.
In the case of someone who is brain dead and whose organs are being donated, the family may visit the bedside but may be faced with a person who looks perfectly normal. The chest moves up and down because of the mechanics of the ventilator, the body may be intact except for the internal head injury and the person is warm to the touch. It is a difficult situation, but one that families need to understand if they are to comprehend the death and donation process.
Because this is a trying time for family members, organ donation is not always easy to talk about. This is why discussion beforehand is so strongly encouraged. The best time to discuss organ donation for the first time is not during the grieving period. If the family members have discussed the issue before, the decision is much easier and they can begin to feel that in some way, their loved one will go on living through others. The decision to donate often eases some of the pain, and is especially comforting when the family members know their relative’s wishes.
It has also been found that most families find a great deal of comfort in organ donation. They feel that something positive has come from an otherwise tragic event. This feeling of comfort is even stronger when they know for sure, based on previous discussion, that their loved one supported organ donation.