Occasionally, a person's limbs or torso (the upper part of the body) may move, even after brain stem death has been diagnosed. These spinal reflex movements are generated by the spinal cord and don't involve the brain at all. Therefore, they won't affect the diagnosis of brain death.
Of the 436 brain dead patients, 74 (17.0%) exhibited reflex or spontaneous movements. Of these, 45 (60.8%) exhibited reflex movements only, 18 (24.3%) exhibited spontaneous movements only, and 11 (14.9%) exhibited both.
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.
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. In addition, the brain can no longer tell the body to breathe.
Earlier this year, 13-year-old Trenton McKinley from Alabama and his parents hit the media circuit to talk about the miracle of Trenton awakening after being declared brain dead from a vehicle accident—1 day before his organs were scheduled to be harvested.
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.
Some patients who have entered a vegetative state go on to regain a degree of awareness (see Minimally Conscious State). The likelihood of significant functional improvement for VS/UWS patients diminishes over time. There are only isolated cases of people recovering consciousness after several years.
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.
Gasping is a brainstem reflex; it is the last respiratory pattern prior to terminal apnoea. Gasping is also referred to as agonal respiration and the name is appropriate because the gasping respirations appear uncomfortable, causing concern that the patient is dyspnoeic and in agony.
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.
Brain death results from swelling in the brain; blood flow in the brain ceases and without blood to oxygenate the cells, the tissue dies. It is irreversible. Once brain tissue dies, there is nothing that can be done to heal it.
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.
What happens after brain death is confirmed? Once someone has been confirmed as brain dead, and before anything else is done, the ICU doctor will meet with their immediate family to explain the situation and decide when the ventilator should be switched off and the heart allowed to stop.
Brain death diagnosis requires presence of 3 conditions: persistent coma, absence of brainstem reflexes, and lack of ability to breathe independently.
The most common movements observed in brain death include flexor or extensor plantar response, triple flexion, abdominal reflex, cremasteric reflex, tonic neck reflexes, and isolated jerks of the upper extremities [23].
The immediate aftermath of dying can be surprisingly lively. For the first few minutes of the postmortem period, brain cells may survive. The heart can keep beating without its blood supply. A healthy liver continues breaking down alcohol.
“Our data shows that a dying brain can respond to sound, even in an unconscious state, up to the last hours of life.”
In the hours before death, most people fade as the blood supply to their body declines further. They sleep a lot, their breathing becomes very irregular, and their skin becomes cool to the touch. Those who do not lose consciousness in the days before death usually do so in the hours before.
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.
Physical signs
Facial muscles may relax and the jaw can drop. Skin can become very pale. Breathing can alternate between loud rasping breaths and quiet breathing. Towards the end, dying people will often only breathe periodically, with an intake of breath followed by no breath for several seconds.
As you get closer to the end of your life, you should still expect to have some bowel movements, even if you aren't eating much. Constipation can be an uncomfortable side effect of many medications. The most common are those to treat pain, nausea, and depression, but other medications can also cause it.
And when is the right time to unplug the outlet? If doctors believe there is little or no chance of recovery, family and loved ones can apply for a court order to remove the patient from life support (which is not necessary if the patient or someone with power of attorney has signed a DNR order).
Their eyes may also randomly wander or track moving objects, and their breathing and heart rate are able to keep their body going without the assistance of machines. Other actions such as swallowing, smiling, and tearing up as well as groaning, grunting, or screaming are all common in vegetative states too.
Generally, most patients at a hospital do come out of a coma. Typically, a coma does not last more than a few days or couple of weeks.