The diagnosis of brain death is primarily clinical, and consists of three essential findings: irreversible and unresponsive coma, absence of brain stem reflexes, and apnea.
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.
If there's no sign of brain activity, doctors sometimes test again 6 to 24 hours later to make sure the person again shows no response. After testing twice with no response, doctors know that the person is brain dead.
Visual aids help the family understand what they cannot see, since the patient's body remains warm and normal in color while maintained on the ventilator. After declaration, refer to brain death as “death,” and tell the family the time of death. The patient is not in a coma.
Without the brain, the body does not secrete important hormones needed to keep biological processes — including gastric, kidney and immune functions — running for periods longer than about a week.
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. Jahi's mother, Nailah Winkfield, has said, “I would probably need for my child's heart to stop to show me that she was dead.
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.
There are a number of criteria for diagnosing brain death.
a person must be unconscious and fail to respond to outside stimulation. a person's heartbeat and breathing can only be maintained using a ventilator. there must be clear evidence that serious brain damage has occurred and it cannot be cured.
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.
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.
Contrary to previous notions that brain cells die within 5 to 10 minutes, evidence now suggests that if left alone, the cells of the brain die slowly over a period of many hours, even days after the heart stops and a person dies.
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).
It is the complete stopping of all brain function and cannot be reversed. It means that, because of extreme and serious trauma or injury to the brain, the body's blood supply to the brain is blocked, and the brain dies. Brain death is death. It is permanent.
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.
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.
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.
Two senior doctors must perform separate tests at the bedside to determine whether the brain is working or not. These doctors check to see if the cranial nerves that pass through the brain stem and control all vital reflexes are working. They also check to see if the person: has any response to pain.
An individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead. A determination of death must be made in accordance with accepted medical standards.
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.
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.
Your loved one may become restless and pull on bed linens or clothing, hallucinate, or even try to get out of bed, due to less oxygen reaching their brain. Repetitive, restless movements may also indicate something is unresolved or unfinished in the person's mind.
They cannot speak and their eyes are closed. They look as if they are asleep. However, the brain of a coma patient may continue to work. It might “hear” the sounds in the environment, like the footsteps of someone approaching or the voice of a person speaking.
Individuals may even occasionally grimace, cry, or laugh. A coma rarely lasts beyond two to four weeks.