Brain Death Flashcards
Organ Donation is ___________ & tissue donation is .____________
lifesaving
life-enhancing
In organ donation the donor patient must be:
Whereas in tissue donation the patient is:
Patient must be maintained by a mechanical ventilator
Donation occurs after death
How long does organ donation vs tissue donation take?
The process is lengthy from referral to procurement 24-72 hours
Ocular Donation process takes about 8 hours.
TIssue donation occurs:
after death.
True or false: organ donation occurs while the individual is still alive
False
organ donation process must begin while the individual has a beating heart so that their organs are still being perfused. Only after death donation occurs.
Criteria for Organ Donation
GIVE
- Grave Prognosis
- Injured brain/non-recoverable illness
- Ventilated
- End of Life Discussion Plan
2 Types of Death
- Death Determination by. Neurological Criteria (DNC - brain death)
- Death Determination by Circulatory Criteria (DCC - cardio-pulmonary death)
Define DNC
irreversible loss of the capacity for consciousness combined with the irreversible loss of all brainstem functions, including the capacity to breathe
Spinal cord reflexes may still be intact
Define DCC
determination of physical death by circulatory based, still has blood flow to brainstem.
There is severe but incomplete brain damage where there is no chance of recovery or meaningful recovery. There is still blood flow to the vital brain centres.
Explain patho of DNC
Known/Definitive Cause of Injury to brain
- arrest of blood flow due to catastrophic intracranial HTN
- brain injury/edema/mass increasing ICP
- Impaired cerebral blood flow
- pressure related ischemia; continued rise in ICP
- Brain herniates through path of least resistance (brainstem/cerebellum)
6 Physiological Criteria of DNC
- Complete and irreversible – stopping of all brain function
- Unresponsive & Irreversible coma
- Definitive cause
- Absent centrally mediated motor responses.
- Absent brainstem reflexes.
- Apnea
DNC Organ Donor patients will always be cared for in the _____ and transferred to the OR for organ recovery still on ______________
ICU
Life support measures
Clinical Manifestation of DNC
- Conning
- Period of instability characterized by HTN, Bradycardia, irregular respirations
AKA
Cushing triad is, unfortunately, a late sign of increasing ICP and indicative that brainstem herniation is imminent.
o Widening pulse pressure
o Bradycardia
o Cheyne Stokes
Prerequisites required before DNC can be determined:
- Clinical imaging showing evidence of a acute catastrophic injury, that supports a diagnosis of brain death.
- No severe electrolyte imbalances.
- No drastic acid base disturbance.
- No endocrine abnormalities.
- No drugs intoxication. Including medications given at hospital. (neuro blockade agents, sedation ect)
- Appropriate core temp
7 Determinants of Brain Death (DNC)
- Definitive cause of death must be identified
- Deep unresponsive Coma: GCS 3
- Body temperature: >36 for Infants-adults
- All sedation, narcotics and neuro-blockade agents stopped
- Absence of spontaneous movements & elicited movements (seizures/posturing)
- Absent brain stem reflex
- DNC is determined by 2 attending physicians with skill and knowledge of patients with severe brain injury and DNC. The clinical assessment can be done concurrently.