What does brain death look like? Brain dead patients look asleep, but they are not. They do not hear or feel anything, including pain. This is because the parts of the brain that feel, sense, and respond to the world no longer work.
Brain death (also known as brain stem death) is when a person on an artificial life support machine no longer has any brain functions. This means they will not regain consciousness or be able to breathe without support. A person who is brain dead is legally confirmed as dead.
But without brain function, the body eventually shuts down, unless there is medical intervention. Someone on a ventilator may appear to be breathing, but cannot breathe on their own. While the heart usually stops within 72 hours, it could continue beating for “a week or so,” Varelas said.
When someone is brain dead, it means that the brain is no longer working in any capacity and never will again. Other organs, such as the heart, kidneys or liver, can still work for a short time if the breathing machine is left in place, but when brain death is declared, it means the person has died.
A variety of reflex movements have been reported in patients with brain death, such as plantar responses, muscle stretch reflexes, abdominal reflexes, and finger jerks (2). Because the aforementioned reflexes are spinal reflexes, the existence of such reflex movements does not preclude the diagnosis of brain death.
Brain Death Testing
These tests would confirm: the patient has no response to verbal or visual command, the patient is flaccid; pupils are unreactive and fixed; has no oculocephalic, gag, oculovestibular or corneal reflexes; and there is no spontaneous respiration.
Patients may be misdiagnosed as “brain dead” if their doctors fail to order the necessary tests to determine whether or not they are aware of their condition and unable to communicate. Individuals who have suffered severe brain injuries need to be accurately diagnosed to receive the best possible care and treatment.
The first organ system to “close down” is the digestive system. Digestion is a lot of work! In the last few weeks, there is really no need to process food to build new cells. That energy needs to go elsewhere.
The UDDA in combination with the DDR assures patients, families, physicians, and other health professionals that a patient who is brain dead is in fact dead, making removal of organs for life-saving transplantation legally and ethically acceptable.
Can someone hear while on life support? It's hard to say for sure whether people on life support can hear their loved ones and healthcare providers. Small studies suggest it's possible. This probably depends on the level of sedation and how severe any possible brain injury is.
People in a vegetative state can open their eyes, but they cannot speak or do things that require thought or conscious intention, and they have no awareness of themselves or their environment.
Brain death is loss of function of the entire cerebrum and brain stem, resulting in coma, no spontaneous respiration, and loss of all brain stem reflexes. Spinal reflexes, including deep tendon, plantar flexion, and withdrawal reflexes, may remain. Recovery does not occur.
Brain death diagnosis requires presence of 3 conditions: persistent coma, absence of brainstem reflexes, and lack of ability to breathe independently.
Cerebral angiography: Four-vessel angiography is the gold standard for tests evaluating cerebral blood flow. It can confirm brain death when it shows cessation of blood flow to the brain.
Clinical death is a term that describes the cessation (stopping) of a patient's heart pumping blood through the body and, inevitably, is paired with a lack of breathing.
When a patient dies, doctors stop treatment and instead focus on organ viability. The body is kept on life-support machinery if the patient was a registered organ donor or while the family makes decisions about organ donation.
However, that person won't ever regain consciousness or start breathing again. Once the brain stem has permanently stopped functioning, there's no way of reversing it and the heart will eventually stop beating, even if a ventilator continues to be used.
Permanent brain damage begins after only 4 minutes without oxygen, and death can occur as soon as 4 to 6 minutes later. Machines called automated external defibrillators (AEDs) can be found in many public places, and are available for home use.
They Know They're Dying
Dying is a natural process that the body has to work at. Just as a woman in labor knows a baby is coming, a dying person may instinctively know death is near. Even if your loved one doesn't discuss their death, they most likely know it is coming.
Even when vascular collapse is the primary event, brain and lung functions stops next. The heart is the last organ to fail.
“Our data shows that a dying brain can respond to sound, even in an unconscious state, up to the last hours of life.”
However no one can recover from brain death. If the clinician has any doubt as to whether there can be even minimal recovery, brain death is not declared. A determination of brain death means that the patient has died; brain death is irreversible.
After the first clinical exam, the patient should be observed for a defined period of time for clinical manifestations that are inconsistent with the diagnosis of brain death. Most experts agree that a 6 hour observation period is sufficient and reasonable in adults and children over the age of 1 year.
It is possible to have a brain injury without having symptoms, but they may surface weeks later. The patient may suddenly experience headaches or dizziness, and it is possible not to remember having the injury.