Brain death is still a controversial topic. Some argue that brain death is not the final death of a person, often mistaking it for a coma. However, doctors argue that brain death is an irreversible process and means the death of the whole organism. What exactly is brain death? How can you determine brain death?

Brain deathis a permanent and irreversible cessation of activity of the whole brain. The death of the brain as a whole can only be determined when the diagnosis isbrain stem death,that is permanent and irreversible cessation of its function (which does not necessarily mean immediate death of all brain cells). Its statement is a necessary but also a sufficient condition to recognize the death of a person.

The brainstem is the part of the brain that controls basic life functions, such as breathing and circulation. The brain stem is very sensitive to hypoxia. Oxygen deficiency causes its death after only about 4 minutes. Only by taking emergency measures within 3-4 minutes of the cessation of respiratory and circulation functions, it is possible to restore its functions without the risk of damaging the neurons, and thus - restoring life.

How is brain death determined?

Brain death is unanimously confirmed by a committee composed of specialists from various fields of medicine: anesthesiology and intensive care, and in the field of neurology and neurosurgery, as well as forensic medicine. They cannot participate in organ procurement and transplantation. Their only task is to declare death.

Brain death - ruling

The diagnosis of brain death consists of two stages: the suspicion of brain-stem death and the performance of tests that confirm the diagnosis. For a brain death to be suspected, it should be stated that:

  • the sick person is in a coma;
  • has no own breath (it is artificially ventilated);
  • cause of coma identified (find out what caused brain damage);
  • structural brain damage has been shown and the damage is irreversible and all therapeutic options have been exhausted;
Important

At this stage, doctors have to make many exclusions. According to the regulations, they must exclude hypothermia or intoxication with drugs (anesthetic, relaxing,with neuroleptics) or drugs. These are conditions that can display symptoms that mimic brain death. It is also necessary to exclude metabolic or endocrine disorders in the form of electrolyte disturbances or glucose, which is necessary for the functioning of the brain. Such diagnosis and confirmation of brain death is not performed in newborns under the 7th day of life.

The fulfillment of the above criteria allows for the suspicion of brain death, and thus - for the commencement of tests confirming the diagnosis. The diagnostic procedure is very detailed. It includes 2 tests, at 3-hour intervals, stating:

  • absence of vertical reflexes;
  • apnea (no respiratory reactivity);
  • no pupil reaction to light;
  • no corneal reflex;
  • no spontaneous eye movement;
  • no pain response;
  • no gag and cough reflexes;
  • no oculocerebral reflex;

Confidence is obtained by examining the brain's electrical activity on an electroencephalogram (EEG) for 12-24 hours. Other studies include the assessment of cerebral circulation and multimodal evoked potentials.

Brain death and disconnection from the ventilator

When brain death does occur, vital vital functions can be sustained by a ventilator so that later organs can be used for transplants for those in need. However, the time of a deceased person in the intensive care unit deteriorates the functioning of the heart, lungs, kidneys, etc. This is because human death is a dissociated process - the brain dies first, then other organs (for this reason, organs are best harvested within 24 hours of a statement of brain death). Eventually, the heart stops beating on its own, even when the patient's vital functions are supported by the apparatus. Therefore, if the family does not consent to organ donation, the doctors (the same members of the junk committee) decide to disconnect the patient from the ventilator, which is often opposed by relatives. Connecting to a life support device gives them the false hope that the patient will recover. They do not realize that cerebral death is not a coma, and disconnection from the ventilator will stop breathing because the breathing center, which is located in the brainstem, is destroyed.

Source: Ministry of He alth

Category:

Neurology