Posted on 11/23/2014 9:49:01 AM PST by Shimmer1
This person might not be a problem. In other cases, however, there seems to be a sausage making haste.
That’s why I would be leery about signing an organ donation authorization. To give someone the shirt off my back while I can meet them is one thing. To say you can give them my guts is something I might not trust you to do right.
One (of many) of the hallmark tests for brain death is an apnea test. You take a patient off vent, giving them only oxygen but no drive.
After several minutes of no respiration, CO2 buildup in the lungs will drive you to breathe, if you have even lower brain function. After several minutes of no observed breathing, a blood gas is drawn and the patient is placed back on vent.
Blood gas will show a dramatic increase in CO2 due to failure to breathe. It’s a two-fold test, watch for breathing and check lab work to see if there were any chemical evidence of respiration (CO2 exchange).
If a patient takes even one breath, the test is over: they aren’t brain dead.
What is not to understand? He said quite clearly that she was breathing after life support was removed. The statute in Texas is quite clear, the patient has to be devoid of respiratory and circulatory function to be considered brain dead. If he is truthful and accurate decisions pertaing to her care are the families by statute. Thus if he is telling the truth accurately the hospital harvesting her organs is actionable. Statists not withstanding.
But according to the article the patient was off the vent and was breathing on her own.
There is no gold standard for brain death. The criteria vary according to location. Different countries have different standards.
Yes, exactly. If you're dead your organs are no good.
BTW in some states you must opt out of being an organ donor, otherwise you are considered to be agreeable.
This is awful.
According to the article, a family member made that claim. I’ve worked critical care for 20 years. Anger and denial are classic initial stages of grief.
The family member, upset about both the accident and the donation, isn’t an objective source.
No way the girl was breathing on her own. That’s the definition of not brain dead.
It’s sensationalism to report the family’s grief-stricken observations as fact. And. Sensationalism sells paper.
The reality is the ME, doctors, and OPO disagreed, and they almost certainly have demonstrable evidence to back up their observations.
You say you must opt out in same states. In a few nations, you must opt out. I don’t believe that is the case in any state. Please cite one, I could be wrong, but I’d be surprised.
And you know this how?
Had a friend who had it happen to his brother. His brother’s wife made the call.
That is one of the dumbest statements on FR I have heard lately. Dead organs are useless, thats why they keep you alive on machines until the organs can be removed.
Anaesthesia for organ donation in the brainstem dead — why bother?
http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2044.2000.055002105.x/full
‘Brainstem dead patients do not require analgesia or sedation …’ for surgery for the retrieval of donor organs. Thus begins the recommendation of the Intensive Care Society (UK) regarding Anaesthesia and Clinical Management During the Donation Operation as published in their booklet of June 1999. The booklet was published to facilitate the establishment of local guidelines for the management of the potential organ donor [1]. However, the relevant section of the document goes on to state that peri-operative neuromuscular blocking agents should be given to prevent reflex muscle contraction and that hypertension may be treated with sodium nitroprusside or a volatile anaesthetic agent such as isoflurane
Some anaesthetists responsible for the clinical management during the donation operation may be uncomfortable with this guidance. Firstly, under few circumstances do we allow operative surgery with muscle relaxation and without analgesia or anaesthesia, leading to a psychological compulsion to provide anaesthesia. Second, the hypertension and tachycardia that accompanies the donation operation can be distressing for operating theatre personnel to witness and for this reason alone one should always administer anaesthesia or agents to control these reflexes. The procedure causes a mean increase in blood pressure of 31 mmHg and a mean heart rate increase of 23 beat.min−1 [2]. This haemodynamic response could be considered to represent an organism in distress and probably occurs at a spinal level, although we are unaware of EEG studies during organ collection to confirm this. Third, death is not an event but a process and our limited understanding of the process should demand caution before assuming that anaesthesia is not required. Historically, death was easily established by the presence of coma, apnoea and pulselessness. Failure of the cardiovascular or respiratory systems invariably led to a rapid failure of the other two. Recent technology has allowed the temporary maintenance of respiration and the circulation by artificial means even when there is irreversible loss of brain function. The concept of ‘brain death’ has emerged both to establish futility and to enable beating heart cadaveric organ donation. Initially, the definition of brain death required the loss of all function of the nervous system [3]; however, it was soon realised that the cerebral hemispheres and brainstem could die with persistent function of the spinal cord.
...Whereas brainstem death is an acceptable definition of death in the UK, the position in the USA has been defined by a President's Commission and requires the ‘irreversible cessation of all functions of the entire brain, including the brainstem’. In the UK, the presence of cortical activity and/or perfusion is regarded as acceptable in the knowledge that the reticular formation will not be functional if the brainstem reflexes are absent and so the capacity for consciousness is irreversibly lost..
‘Brainstem dead patients do not require analgesia or sedation …’ for surgery for the retrieval of donor organs. Thus begins the recommendation of the Intensive Care Society (UK) regarding Anaesthesia and Clinical Management During the Donation Operation as published in their booklet of June 1999. The booklet was published to facilitate the establishment of local guidelines for the management of the potential organ donor [1]. However, the relevant section of the document goes on to state that peri-operative neuromuscular blocking agents should be given to prevent reflex muscle contraction and that hypertension may be treated with sodium nitroprusside or a volatile anaesthetic agent such as isoflurane
Some anaesthetists responsible for the clinical management during the donation operation may be uncomfortable with this guidance. Firstly, under few circumstances do we allow operative surgery with muscle relaxation and without analgesia or anaesthesia, leading to a psychological compulsion to provide anaesthesia. Second, the hypertension and tachycardia that accompanies the donation operation can be distressing for operating theatre personnel to witness and for this reason alone one should always administer anaesthesia or agents to control these reflexes. The procedure causes a mean increase in blood pressure of 31 mmHg and a mean heart rate increase of 23 beat.min−1 [2]. This haemodynamic response could be considered to represent an organism in distress and probably occurs at a spinal level, although we are unaware of EEG studies during organ collection to confirm this. Third, death is not an event but a process and our limited understanding of the process should demand caution before assuming that anaesthesia is not required. Historically, death was easily established by the presence of coma, apnoea and pulselessness. Failure of the cardiovascular or respiratory systems invariably led to a rapid failure of the other two. Recent technology has allowed the temporary maintenance of respiration and the circulation by artificial means even when there is irreversible loss of brain function. The concept of ‘brain death’ has emerged both to establish futility and to enable beating heart cadaveric organ donation. Initially, the definition of brain death required the loss of all function of the nervous system [3]; however, it was soon realised that the cerebral hemispheres and brainstem could die with persistent function of the spinal cord.
...Whereas brainstem death is an acceptable definition of death in the UK, the position in the USA has been defined by a President's Commission and requires the ‘irreversible cessation of all functions of the entire brain, including the brainstem’. In the UK, the presence of cortical activity and/or perfusion is regarded as acceptable in the knowledge that the reticular formation will not be functional if the brainstem reflexes are absent and so the capacity for consciousness is irreversibly lost...
Management of the heartbeating brain-dead organ donor
http://bja.oxfordjournals.org/content/108/suppl_1/i96.full
Not sure what state you're in, here in Illinois I'm pretty sure the Nurses and Doctors know.
My younger brother (8 years younger than I..) died of a massive brain aneurysm at the point where the brain and brain stem meet. We were told by the Chief of Neurology at Christ Hospital in Oak Lawn, IL that he was dead before he hit the floor in his home, even though the paramedics were able to revive him (get his heart beating again, get him breathing again.)
By the time I got to the hospital, the hospital neurologists had already evaluated him. They informed my sister, my youngest brother and I that his aneurysm was inoperable and there was nothing they could do for him. His death was certain to come and there was nothing left to do but make him as comfortable as he could be.
I spent the night in his hospital room with him. I was there at 2:42AM on Saturday Morning August 11th 2012 when he passed and the machines took over supporting him (keeping him breathing.) It was during that evening that I learned from the nurse assigned to him that the organ donation "system" had already matched his organs with recipients, and that process started almost immediately after the hospital neurologists informed us our brother had no chance of recovery. All the tests they did (swallow test, sensation tests and others) simply confirmed their conclusion. It would not be until 4pm on Saturday August 11th 2012 that they would finally pronounce him dead.
Within an hour what's left of my small family (sister, younger brother and my brother's two teenage daughters) were escorted to a room where we were informed of my brother's organ donation status (he was a donor) and that the following morning they'd be harvesting his organs as recipients were being flown in.
The organ donation "system" had started monitoring my brothers status minutes after he arrived at the hospital. It was the nurse assigned to him who told me so as I sat with my brother as he passed from this life onto the next.
You'll have to pardon me if I just do not believe you when you say the nurses don't know and only find out after the fact. Nurses do know based on the drugs they're putting into the IV whether or not they're keeping someone "going" long enough to be an organ donor. They know which drugs are intended to keep the heart beating even though the brain has shut down because the blood supply had been cut off to it. They know which drugs they're putting into the IV to keep the lungs "healthy" even though they're on a respirator.
The ICU nurse assigned to my brother told me that.
My brother who passed away from a massive brain aneurysm was himself a nurse. He dedicated himself to caring for the sickest of the sick, so it was no surprise to us that he donated his organs. What *was* a surprise to us is the speed at which the organ donation system seems to operate, the "sterility" of it and from my point of view, the ghoulishness of it all. From the point of their monitoring my brother's status starting minutes after he entered the hospital to the moment he passed just gave me the creeps. It still does.
I dont ask about donor status until someone is declared brain dead. The family can be asked to think about it if it is apparent that is the way things are going, and nurses may ask, but it in no way plays into when or if someone is declared brain dead as some of those here would imply. I’m sorry about your brother, have you had your MRI to be sure you don’t have an aneurysm? They can be hereditary
There are no drugs specifically to prepare the body for organ donation. Once brain death has occurred, it is the same drugs that keep the body going prior to the declaration of brain death that are continued. I’m sorry about your experience feeling sterile, etc. Unfortunately once the decision for donation is made, the donor agency takes over and we have nothing to do with it, as our patient has died. I can tell you after we have a donation the staff has meetings, etc as it is traumatic for them that a (usually) young person has died suddenly and tragically. I would hope the donor agency offers the same to the family.
Organ donation is an emotionally draining situation and deeply personal. I’m glad your brother had made the decision ahead of time sparing you the trauma of having to make the decision in a time of tragedy. God bless you in your grief. But please know in no institution I have worked for does the decision to declare brain death depend in any way on donor status. I’m sickened by those who think it does. Medical professionals are not ghouls, most of us are human and have family members ourselves.....
Yes they can, as we learned during the entire "ordeal." The same Chief of Neurology and his staff that informed us of our brothers condition also told us that the type of aneurysm my younger brother had was in fact hereditary and strongly suggested that my older sister, youngest brother and I all have MRI's/MRA's on our brains.
Looking back on the whole thing, I cannot imagine how a Doctor composes themselves to deliver so much bad news all at the same time. "Your brother is dying, and the type of aneurysm he had is genetic and the three of you need to be tested asap" still rings in my head. I was the only one of the three of us who had the MRI/MRA and I'm fine. I do worry about my sister and younger brother. Neither wanted to know.
There are no drugs specifically to prepare the body for organ donation. Once brain death has occurred, it is the same drugs that keep the body going prior to the declaration of brain death that are continued.
I may have misspoke or not explained what I was told properly. You're correct that the same drugs that are used before brain death are continued after brain death to keep the major organs going. What I meant to say was that the Nurse knew when my brother passed (the machines took over for him) and that by continuing the drugs he (male nurse) knew my brother was an organ donor. He told me as much that he knew.
I’m sorry about your experience feeling sterile, etc. Unfortunately once the decision for donation is made, the donor agency takes over and we have nothing to do with it, as our patient has died. I can tell you after we have a donation the staff has meetings, etc as it is traumatic for them that a (usually) young person has died suddenly and tragically. I would hope the donor agency offers the same to the family.
My younger brother (8 years my junior) was 42 at the time of his death. It was hard all the way around. The suddenness of it combined with our being told we needed to be tested right away was alot to get hit with all at once. I will say the nursing staff at the hospital was just top notch. I can't imagine going through what they do on a daily basis and manage to keep my compassion for others vs. becoming cold to it all.
Organ donation is an emotionally draining situation and deeply personal. I’m glad your brother had made the decision ahead of time sparing you the trauma of having to make the decision in a time of tragedy.
Yes, organ donation does take that decision burden off the family however there were still papers to sign and that responsibility fell on my 19 year old niece as his next of kin. My older sister and I tried so hard to get the organ donation folks let us sign the paperwork to take that burden away from her but they wouldn't let us. Poor girl to this day thinks she signed her fathers death warrant and there's literally nothing any of us can say at this point that we've already said hundreds of times over to convince her otherwise.
I wouldn't wish the entire experience on my worst enemy. Medical professionals are not ghouls, most of us are human and have family members ourselves.....
My "ghoulish" reference wasn't at the nurses or doctors involved in my brothers care. That was directed at the organ donation process/professionals who upon my brothers declaration of death by the chief neurologist told us they'd been following my brothers case since he was admitted to the hospital. They were matching his organs to recipients before he passed. That's ghoulish IMO even though I understand the necessity for what it is they do.
Thanks for your reply. I can tell you're an excellent and compassionate nurse. :-)
It took a while but finally found the article I had read. You are right, the U.S. is completely an opt-in country. It was in Israel that they had opt-in legislation pending.
I remember looking it up because someone from California told me that ‘organ donor’ was on her driver’s license and she hadn’t opted in. She must have agreed to it.
Countries vary tremendously in terms of definition of brain dead and associated legislation. There are a couple of summaries out there on the web.
Maybe in Britain, but I have not seen that here. I’ve only done anesthesia for a few organ harvests thankfully, but I can assure you where I practice an ‘anesthetic’ is given, not just muscle-relaxants (paralytics) and agents to control hemodynamics. I would wager this would be the case at most all US hospitals.
As I understand it, organs have to be transplanted within 24 hours of the donor’s death. Beyond that they are not viable
Not necessarily true, especially for brain-dead donors as opposed to cardiac-death donors. A young healthy brain-dead individual with good cardiac function maintained on a ventilator can preserve the body’s organs for days.
Obviously sooner is better, but I am not aware of any defined timeline in a case such as the one presented.
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