You may have seen in movies and TV series that a person has suffered brain death and doctors, unlike his family, believe that everything is over and they can do nothing. Does this mean the end of life? Read on to find out what brain death is and how it is diagnosed.
When does brain death occur?
Brain death is the irreversible condition of all brain functions. This condition occurs when a patient dies without the help of supportive devices and treatments (such as a ventilator). In some cases, a patient with brain death may volunteer to donate an organ.
This condition, sometimes confused with coma, is one of the definitive criteria for death. However, the person who is in a coma is unconscious but still alive. If the patient is unable to survive without supportive therapies, such as a ventilator, he or she will have brain death.
This problem may occur after a heart attack or stroke. Under these conditions, the heart rate continues; While the ventilator delivers oxygen to the lungs. The heart can continue to beat without nerve signals from the brain. However, despite the beating heart and warm skin, the person is dead. Because the brain has stopped working, the person will not be able to breathe if the respiratory system is turned off.
Why does brain death occur?
Here are some causes of brain death. However, the causes are not limited to the following:
- Trauma to the brain (eg severe head injury from a motor vehicle accident, bullet, fall or head injury);
- Anoxia or lack of oxygen (for example, drowning or heart attack);
- Cerebrovascular damage (eg stroke or aneurysm);
- Brain Tumor.
What is the difference between brain death and coma?
Brain death differs from other forms of anesthesia in many ways; Coma, for example, is similar to deep sleep, except that no external stimulus can awaken the brain. However, the person is alive and recovery is possible. This condition is often confused with stable vegetative state or plant life. However, these conditions are not the same. The vegetative state of life means that the person has lost the functions of a large part of the brain, the brain; But the brainstem is not damaged and continues to perform essential functions such as heart rate and respiration.
Brain death and family reunification
Because brain death devices protect a person’s breathing and heart rate, their bodies are warm to the touch. These conditions create the illusion that the person is still alive. Family members may have a false hope that the person is only under anesthesia and may wake up over time or treatment. It is important for medical staff to fully explain that this is the final stage and that the person is dead and has no chance of regaining consciousness.
Brain death and organ donation
In some cases, a person with brain death may volunteer to donate an organ. If the donor has registered or if their family has expressed a desire to donate an organ, his death will be announced; But the ventilator stays connected.
Drugs that help maintain the function of internal organs are still prescribed to the patient. The person is then operated on to remove living organs, such as the kidneys. After the operation, the respiratory tract is turned off and then the funeral and burial can be performed.
Diagnostic tests for brain death
There are a number of conditions that must be met to declare brain death. Briefly to announce brain death:
- Coma must have a known and irreversible cause;
- One should not have any brainstem reflexes;
- The person has no respiratory function.
All three conditions must be met to declare brain death.
1. Diagnosis of irreversibility and cause of coma
Before the doctor can determine if the coma is irreversible, he must find a way to get the patient back. To do this, the medical team must first determine the cause of the coma. In addition, the medical team must identify and eliminate any conditions that may resemble brain death, such as hypothermia, drug poisoning, metabolic abnormalities, or neuromuscular factors that may cause “death-like” paralysis. All of these items are probably reversible in varying degrees.
Confirmation of irreversibility of a coma requires the physician to wait a certain amount of time based on the known cause. This is a decision that must meet medical and legal standards.
2. Detection of brainstem reflexes
Brainstem reflexes or involuntary brainstem reactions are automatic responses that are no different from knee-shaking tests in a doctor’s office. These are involuntary reactions that indicate that a person’s nervous functions are normal or abnormal or completely gone.
If a person does not respond to all of the following reflex stimuli, brain death is diagnosed:
- Lack of corneal reflex means that when the doctor touches the eye with a swab or a drop of water, it does not blink and has no response;
- The lack of pupil reflex means that the pupil of the eye does not react to them when the light is on. If the person is alive, the pupils of the eyes become smaller;
- Lack of pharyngeal reflex means that the person does not experience laryngeal spasm, cough, or react when touched the back of the throat with a cotton swab or suction device;
- The absence of an eye reflex (also known as the “doll eye” reflex) means that when a person moves his head from side to side, his eyes do not remain fixed on the examiner’s face;
- Failure to respond to the cold caloric reaction test means that when ice water is poured into a person’s ear, the person does not react. If the person is alive, the stimuli cause their eyes to move in the opposite direction, because this test tricks the inner ear into thinking that the person is spinning.
3. Detection of lack of respiratory function
The last step in determining brain death is the apnea test. Apnea is a medical term for cessation of breathing, and in this case, it is used to ensure that the cessation is permanent. To perform an apnea test, your doctor will perform the following steps:
- The person in the ventilator is connected to a pulse oximeter. This device is used to measure oxygen saturation in the blood;
- The ventilator is then disconnected and a tube is inserted into a person’s trachea to deliver 100% oxygen to the lungs. This ensures that the person does not lack oxygen if they respond;
- A blood test is done immediately to measure blood gases;
- The doctor then waits for 8 to 10 minutes to see if there is a response from the patient;
- After 8 to 10 minutes, the blood gases are tested again.
If there is no respiratory movement and the PaCO2 (pressure of carbon dioxide in the arteries) rises to more than 60, it means that there is no exchange of oxygen and carbon dioxide in the lungs and the person is declared brain dead. If a respiratory movement is observed, the person cannot be considered dead. In this case, more research is done to determine if the patient can be returned to normal.
4. Supplementary tests
No additional tests are needed if a complete clinical examination (including brainstem reflexes and apnea tests) and brain death are reported. However, due to the special nature of the diagnosis, in most hospitals today, qualified physicians perform confirmatory examinations after a certain period of time.
In some cases, additional tests may be performed if a facial injury, spinal cord injury, or other factor allows for a standard evaluation. These additional tests may give family members more reassurance that the diagnosis has been made correctly.
Answers to frequently asked questions
1. What does brain death mean?
When a person suffers from brain death, it means that his brain is no longer active and never returns to its previous state. Other parts of the body (such as the heart, kidneys, and lungs) work for a while if the ventilator is attached to the patient. However, when this condition is diagnosed in a person, it means that he has died.
2. Is there a case for a person with brain death to come back to life?
No. Sometimes most people assume this condition to be the same as a coma and think that over time or with treatment, the person will come back to life. However, this situation is equal to death and there is no return.
3. Is brain death similar to coma or plant life?
No. This situation is no different from death. A person in a coma or vegetarian life is actually alive, and some brainstem functions continue, one of which is breathing control. When a person dies of brain death, none of the other parts of the brain function and become completely dysfunctional.
4. What causes brain death?
Brain death may occur as a result of accidental injury or illness. High blood pressure can also cause bleeding in the brain, leading to death. A brain infection, brain tumor, or injury can cause the brain to swell as well as die.
5. How does a doctor diagnose brain death?
Doctors use a variety of tests to diagnose brain death, including a diagnosis of irreversibility, a lack of brainstem reflexes, and a lack of respiratory function.