Elsevier

Critical Care Clinics

Volume 30, Issue 4, October 2014, Pages 813-831
Critical Care Clinics

Brain Death and Management of a Potential Organ Donor in the Intensive Care Unit

https://doi.org/10.1016/j.ccc.2014.06.010Get rights and content

Section snippets

Key points

  • The concept of brain death developed with the advent of mechanical ventilation, and guidelines for determining brain death have been refined over time.

  • The most current guidelines, the 2010 American Academy of Neurology practice parameters for brain death determination in adults, necessitate 3 clinical findings: irreversible coma from a known cause, brainstem areflexia, and apnea.

  • Despite efforts to develop standardized guidelines, there is a large degree of practice variability, including the

Practice Before the American Academy of Neurology Guidelines

In 1968, a committee commissioned by Harvard Medical School involving physicians, a theologian, a lawyer, and a historian of science examined irreversible coma as a new criterion for death.7 In their report, coma in an individual with no discernible central nervous system (CNS) activity was defined by 4 features: (1) unreceptivity and unresponsiveness; (2) absent movements or breathing; (3) absent reflexes; and (4) an isoelectric electroencephalogram (EEG).8 Confounders such as hypothermia

Management of potential organ donor

Patients in the intensive care unit (ICU) declared dead by neurologic criteria (or by circulatory criteria) are potential organ donors. Because of the shortage of available organs for donation, optimizing appropriate management of potential donors is of great importance.43, 44, 45, 46, 47 One donor has the potential to affect the lives of 7 or more people.

The family meeting

The family meeting is an important time to understand the patient’s wishes, afford an opportunity to comfort the family, address their needs, and set the tone to deliver bad news in a compassionate manner, a hallmark of high-quality ICU care.68 It is important to establish a relationship with the family before the discussion of brain death, preferably before brain death testing, so that the family can understand the treatment plan and steps that will be taken in the care of their loved one.

Summary

With technological advances such as positive pressure ventilation and organ transplantation, modern medicine has caused a reevaluation of our basic presuppositions about the biological phenomenon of death, for which society has constructed pragmatic, medical, moral, and legal policies.72 Despite periodic controversy, a vast majority consensus exists on what constitutes brain death and which criteria are necessary in its determination. A similar consensus exists on the dead donor rule, which

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    Conflicts of Interest: The authors have no relevant conflicts of interest to declare.

    Disclosures: None.

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