Materiały źródłowe

• #1 Brain Death: What It Is, Stages & Criteria

  https://my.clevelandclinic.org/health/diseases/brain-death

  Brain death is when a medical condition like a stroke or a traumatic brain injury causes major and permanent damage to your brain. In brain death, you’re unconscious and you can’t breathe on your own. Healthcare providers follow medical criteria (guidelines) before diagnosing brain death. They perform specific tests before making a final diagnosis. […] Brain death is the medical and legal term for death that happens when your brain stops working. In brain death, injury or illness does severe, permanent damage to your entire brain and brainstem. Your brainstem manages your breathing and heart rate. Your brain manages senses like sight, sound and touch, and abilities like motor movement. […] Because people’s brains drive these essential functions, someone is legally dead when they’re diagnosed with brain death. Healthcare providers follow established medical criteria (guidelines) to determine if someone is brain dead. For example, they rule out all other possible causes before they do specific tests that diagnose brain death.

• #2

  https://www.nhs.uk/conditions/brain-death/

  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. They have no chance of recovery because their body is unable to survive without artificial life support. […] If someone is brain dead, the damage is irreversible and, according to UK law, the person has died. […] But they will not ever regain consciousness or start breathing on their own again. They have already died. […] After brain death, it is not possible for someone to remain conscious. […] Brain death can happen when the blood or oxygen supply to the brain is stopped. […] Brain death is permanent. […] Organ donation may be possible after brain death, as the person’s organs can be used in transplants, which can often save the lives of others.

• #3 Diagnosis of brain death – UpToDate

  https://www.uptodate.com/contents/diagnosis-of-brain-death

  Brain death signifies the complete, irreversible cessation of brain function, including the capacity for the brainstem to regulate respiratory and vegetative activities. It was first described in 1959, predating widespread organ donation, which has since made its codification critically necessary. While most countries have a legal provision for brain death, institutional protocols for diagnosis are not universal and are often absent, particularly in lower-income countries and in those without an organized transplant network. Even among countries with an organized diagnostic protocol, there is substantial variation in the criteria that are used. […] While United States law equates brain death with cardiopulmonary death, specific criteria for diagnosis are not mandated. Some states and institutions have specific diagnostic mandates, especially when applied to organ donor candidates. Most clinicians rely on published guidelines. However, surveys of academic institutions in the United States have found that there is considerable variability in adherence to published guidelines and clinical practice. Variable documentation of brain death criteria was also observed in a series of 142 children referred for organ donation, and in a chart review of 226 organ donors collected from 68 hospitals in the Midwest United States. […] In most adult series, trauma and subarachnoid hemorrhage are the most common events leading to brain death. Others include intracerebral hemorrhage, hypoxic-ischemic encephalopathy, and ischemic stroke. Any condition causing permanent widespread brain injury can lead to brain death.

• #4 Brain Death | Saint Luke’s Health System

  https://www.saintlukeskc.org/health-library/brain-death

  Brain death means the brain no longer functions. No blood is flowing to the brain. The thinking part of the brain (cerebrum) as well as the part of the brain responsible for breathing and reflexes (brain stem) no longer work. Brain death is diagnosed when 3 conditions exist. […] Doctors and other healthcare personnel take great care to verify a person brain dead. A coma or being in a vegetative state is not the same as brain death. Various tests are done to confirm the diagnosis. […] Any major injury to the brain can cause brain death. This includes things such as a stroke, injury from an accident, lack of oxygen to the brain such as from drowning or cardiac arrest, a brain infection, or liver failure. Brain death cannot be reversed. […] The healthcare provider will look for signs of brain death such as: Pupils dont respond to light, Person cant breathe on their own, There is no cough or gag reflex, No reaction to pain, Eyes dont blink or move when touched.

• #5

  https://www.nursingcenter.com/journalarticle?Article_ID=5288681&Journal_ID=54030&Issue_ID=5288581

  ABSTRACT: In 1968, the criteria for brain death were established by the Harvard Ad Hoc Committee. […] This article provides an overview of the development of brain death criteria, describes recent controversies and updates, and discusses implications of these criteria for nurses. […] Nurses need to be prepared to answer patient and family questions on the subject. […] Nurses in the critical care setting may encounter brain death cases that become ethically complex. […] When brain death is suspected, a clinical assessment is performed, which typically involves testing to establish the following: irreversible loss of consciousness and its proximate cause. […] The brain death testing process is very challenging for families as they grapple with the possibility that their loved one has died.

• #6 Care of brain dead | PPT

  https://www.slideshare.net/slideshow/care-of-brain-dead/160584146

  1. Nursing Management of Brain Dead patients Prof. Prabhjot Saini Professor of Medical Surgical Nursing Dept. DMCH College of Nursing Ludhiana, Punjab […] 2. It is no wonder that families of brain dead patients frequently react to this news with denial: How could my loved one be dead if her heart is still beating? […] 3. Brain death concepts Prior to the advent of mechanical respiration, death was defined as the cessation of circulation and breathing Immensely challenging concept to grasp […] 4. Historical perspective 1968 Irreversible Coma/Brain Death -Harvard Medical school Ad Hoc Committee. 1981 UDDA Presidents commission for the study of ethical problems in medicine. 1994 American academy of neurology Guidelines for the determination of brain death Accepted by Govt. of India in 1994 as a form of death. 2005 NYS guidelines for determining brain death

• #7 Brain Death: What It Is, Stages & Criteria

  https://my.clevelandclinic.org/health/diseases/brain-death

  The term medical criteria refers to the steps healthcare providers must take in diagnosing brain death. In the U.S., three medical societies collaborate on criteria. Before providers can do tests to diagnose brain death, they: Identify and treat any underlying condition that’s causing severe brain damage. Rule out potential issues and conditions that could be why someone has severe brain damage. Rule out conditions or issues that could cause symptoms that mimic brain death. […] Healthcare providers with special training in brain death do several tests. They may do tests more than once to confirm their initial diagnosis. If your provider suspects you have brain death, they’ll tell your family about the tests and what the tests might show. Tests include a physical examination, imaging tests like a brain MRI, an extensive neurological examination and an apnea test.

• #8 How Educators Can Help Prevent False Brain Death Diagnoses | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/how-educators-can-help-prevent-false-brain-death-diagnoses/2020-12

  In a survey of physicians who perform brain death examinations, only 25% reported compliance with current practice guidelines. […] The team informed the family that the patient was not brain dead. […] A decision was made to withdraw artificial support and the case was discussed at the morbidity and mortality conference. […] Most of the prerequisites for the determination of brain death are meant to exclude brain death mimics, such as hypothermia, drug intoxications, Guillain-Barr syndrome, locked-in syndrome, and metabolic encephalopathies, including electrolyte, acid-base, or endocrine disturbances. […] In addition to the patient not meeting prerequisites for determination of brain death, there were 2 contraindications to apnea testingparenchymal lung disease/CO2 retention and high cervical spinal cord injury.

• #9 Brain Death: What It Is, Stages & Criteria

  https://my.clevelandclinic.org/health/diseases/brain-death

  The term medical criteria refers to the steps healthcare providers must take in diagnosing brain death. In the U.S., three medical societies collaborate on criteria. Before providers can do tests to diagnose brain death, they: Identify and treat any underlying condition that’s causing severe brain damage. Rule out potential issues and conditions that could be why someone has severe brain damage. Rule out conditions or issues that could cause symptoms that mimic brain death. […] Healthcare providers with special training in brain death do several tests. They may do tests more than once to confirm their initial diagnosis. If your provider suspects you have brain death, they’ll tell your family about the tests and what the tests might show. Tests include a physical examination, imaging tests like a brain MRI, an extensive neurological examination and an apnea test.

• #10 Brain death: a clinical overview | Journal of Intensive Care | Full Text

  https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-022-00609-4

  Once the above criteria have been established, it must be proven that the brain injury is irreversible, meaning that loss of function is complete and constant over time. […] After establishing a comatose state with complete unresponsiveness to maximal stimuli, determination of BD/DNC includes assessment for loss of brainstem reflexes, as follows: loss of pupillary responsiveness, loss of corneal, oculocephalic, oculovestibular, gag, and cough reflexes, absence of facial movement to noxious stimuli, and absence of cerebrally mediated movement to noxious stimulation of the extremities. […] The goal of apnea testing is to create a buildup of carbon dioxide that maximally stimulates the medullary respiratory centers, which are ultimately triggered by the ensuing acidic pH of the cerebrospinal fluid (CSF).

• #11 FF #115 Declaring Brain Death: The Neurologic Criteria | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/declaring-brain-death-the-neurologic-criteria/

  Fast Fact Number: 115 […] Background This Fast Fact reviews the details of declaring death based on neurological criteria. In 1980, the Uniform Determination of Death Act (UDDA) was created which stated that “An individual who has sustained either 1) irreversible cessation of circulatory and respiratory function, or 2) irreversible cessation of all functions of the entire brain, including the brainstem, is dead. A determination of death must be made with accepted medical standards.” The UDDA did not define “accepted medical standards,” and so the American Academy of Neurology published guidelines in 1995, and updated them in 2010. Despite these national guidelines, there is still considerable variability in local institutional guidelines. […] Determining death by neurologic criteria involves two steps: […] Step 1: Rule out reversible causes of unconsciousness: sedative medication, neuromuscular blocking agents or hypothermia. […] Step 2: Rule out the presence of cortical activity and brainstem reflexes using clinical exams/tests. The exact tests done may vary by institution and one should check with their own institution’s policies. Brain death exams are typically completed by neurologists, neurosurgeons, and critical care physicians. For a person to be dead by brain death, typically all of the following tests must show lack of brain function: […] No spontaneous movement and no movement in response to painful stimuli (movement due to spinal reflexes are acceptable). […] No seizures, decerebrate or decorticate posturing, or dyskinetic movements. […] Absent cranial nerve reflexes including pupillary response to light, corneal reflexes, oculocephalic reflex, caloric response, facial movement to a noxious stimulus, and gagging and cough with suctioning. […] Caloric testing is done by first ensuring the auditory canal is clear and the tympanic membranes are intact. The head is elevated to 300, 50 ml of ice water is slowly infused into the canals, and the eyes are observed for one minute. The normal response in an awake patient is tonic deviation of the eyes toward the cold stimulus followed by nystagmus back to the midline; the normal response in a comatose patient with an intact brainstem is tonic deviation of the eyes toward the cold stimulus without nystagmus; in brain death, the eyes do not move. Both ears must be tested with an interval of several minutes in between. […] Note: At some institutions other clinical tests are done before a formal apnea test (see below). For example, some require documentation of no vagal nerve activity – an atropine test is used. The patient is given 2 mg IV atropine. In the dead patient, the parasympathetic outflow is non-functioning and the heart rate will not change (<10 beats/minute). [...] Absence of central respiratory drive is assessed using the apnea test to see if a rise of CO2 provides a stimulus to breathe. The patient is ventilated with 100% oxygen for 10-20 minutes and a baseline blood gas is obtained. The ventilator is then removed while 100% oxygen is delivered; O2 saturation is continuously assessed. A follow-up ABG is done after 5-10 minutes. If the PaCO2 rises past 60mm Hg (or >20 mm Hg above baseline), and no breathing efforts are observed, the respiratory center is not functioning. The test should be aborted if the patient develops hypoxemia (also indicates no respiratory drive), hypotension, or arrhythmias.

• #12 Updated Brain Death Guidance: What Care Teams Need to Know | SCCM

  https://www.sccm.org/communications/sccm-podcast/sccm-podcast-all-episodes/sccm-pod-533-ccm-updated-brain-death-guidance-what-critical-care-teams-need-to-know

  We provide a little bit of additional clarity in terms of doing the neurologic examination. […] In pediatrics, we’re required to have two neurologic examinations and two apnea tests, and those are separated by an interval of 12 hours. […] In adults, one exam and one apnea test are required. […] We recommend that a second exam can be done, which will help decrease the likelihood of a false-positive brain death determination. […] One of the things that we emphasize in the guidelines that were published at the end of last year is that practitioners who perform the evaluation should be adequately trained and competent in performing the evaluation. […] The 2023 multi-society guideline statement that we have been talking about here is considered the accepted medical standard. […] What the panel decided and what has been written into the guidelines is that you have a duty to inform families that you are going to proceed with a brain death evaluation.

• #13

  https://www.iowadonornetwork.org/professional-partners/hospital-professionals/organ-donation-process/brain-death-ddnc

  In 2010, the American Academy of Neurology updated guidelines for determining brain death in adults. […] Once the neurological examination is completed, an apnea test should be conducted. […] An apnea test is considered positive if the PCO2 is 60 mmHg or rises 20 mmHg normal baseline value. […] In instances in which a component of the neurological examination or apnea test cannot be completed, ancillary testing can be used to confirm brain death. […] In pediatrics, it is recommended that two physicians must perform independent examinations separated by specified time intervals. […] Time intervals between tests should be at least 24 hours unless an ancillary study is performed and is consistent with brain death. […] Time intervals between tests should be at least 12 hours unless an ancillary study is performed and is consistent with brain death.

• #14

  https://journals.lww.com/nams/fulltext/2018/07030/the_nursing_challenges_of_caring_for_brain_dead.5.aspx

  Caring for brain-dead patients is one of the hardest duties for nurses, particularly in Intensive Care Units (ICUs). […] This study aimed to explore the nursing challenges of caring for patients diagnosed with brain death. […] Seven themes were extracted from the data: uncertainties and conflicts between physicians and nurses, tensions in breaking the news of patient’s brain death to families, stressful experience of caring for the first time, nurses’ physical and psychological afflictions due to complex care tensions, stress of being blamed by patients’ family, difficulty in tackling the emotions of patients’ family, and finally, a sense of lack of support and protection in care. […] Since nurses confront chain of tensions while caring for a brain-dead patient, this can affect the quality of this vital role to keep the transplantable organs viable; furthermore, authorities should implement special support programs for nurses.

• #15 Explaining nurses’ experiences of caring for brain dead patients: a content analysis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6122867/

  Caring for patients with brain death diagnosis is the heaviest of duties for nurses, and, due to the complexities and stressors, it is the biggest challenge of nursing in an intensive care unit. […] This qualitative research aimed to disclose the nurses experience of caring for brain-dead patients. […] The findings deepened our understanding and knowledge of the issue. Despite all the stress, nurses care for potential organ donors, and this results in preserving the organs viability for donation. Nurses problems and challenges in this caring process should be considered by policymakers of health and treatment systems and a supportive model be designed for nurses in the intensive care unit. […] One of the issues considered in caring for brain-dead patients is one of the hardest duties for nurses, which is caring for potential organs viability for donation, such that nurses mention their experience of caring for brain-dead patients as a big challenge.

• #16 Care of brain dead | PPT

  https://www.slideshare.net/slideshow/care-of-brain-dead/160584146

  13. Determination of brain death Determination of death by neurologic criteria is a clinical diagnosis. After certain prerequisites are met, there are three essential components to the determination Irreversible coma or Unresponsiveness Absence of brainstem reflexes Apnea […] 14. Who can declare BD? BD diagnosis made by the separate examinations of 2 doctors: 1. One of the doctors specialist as having knowledge in performance of brain death certification Intensivist/ Critical care physician/ Neurologist or neurosurgeon 2. The other medical practitioner of same qualification with atleast 6 years of experience and possess skill and knowledge in performance of brain death certification […] 15. Care of Brain dead patient organ donor management […] 16. Nursing Care of Brain dead donors Technical dimension Bioethical dimension Focus ongoing resuscitation to maintain viable organs Post-declaration management Multitasking and frequent reassessment. Family Support Bereavement care Counseling Obtaining consent for organ donation

• #17 Care of brain dead | PPT

  https://www.slideshare.net/slideshow/care-of-brain-dead/160584146

  17. Technical dimension of nursing care to BD patient Initial donor resuscitation Donor management […] 18. Initial donor resuscitation Immediate goals Establish baseline organ function and stabilize vital signs Maintaining central and arterial line Obtain Blood, urine, and bronchial cultures and baseline chemistries, coagulation profile, CBC Evaluation of lung and heart – chest x-ray, ECG, etc […] 19. Physiological end points for potential donors Systolic blood pressure 90 mm Hg Mean arterial pressure 60 mm Hg Central venous pressure 12 mm Hg PCWP 12 mm Hg Urine output 1 and 4 mL/kg/h Core temperature 35C Hematocrit 25% Oxygen saturation 95% pH 7.35-7.45 […] 20. Conclusion The recognition and acceptance of brain death is the need of the hour Awareness amongst public to support the organ donor and organ donation To improve the numbers and quality of donor organs The nurses need to care to patients who are potential donors of organs and their families, while recognizing the complexity of the process They need better qualification and emotional maturity.

• #18 Care for the brain-dead organ donor | Deranged Physiology

  https://derangedphysiology.com/main/required-reading/organ-and-tissue-donation/Chapter-615/care-brain-dead-organ-donor

  Care of the patient preparing for organ donation after brain death is essentially the support of organ systems which have lost central autonomic and endocrine regulation. The intensivist must step in to the role of the pituitary and hypothalamus, making gross adjustments to parameters which were previously handled by this apparatus. This support consists of pituitary hormone replacement and support of the functions which were formerly performed by the autonomic nervous system. Aggressive support in general (including CPR) is justified on the grounds of it being the fulfilment of the patient’s wishes, who presumably would have supported any measures which facilitate their incredibly generous act. […] The circuit should be humidified. Normoxia and normocapnea must be maintained. There will be periodic requests for ABGs on 100% FiO2 from the donor coordinator, but afterwards the FiO2 must be minimised to prevent oxidative stress damage to the lungs. Haemodynamic instability is to be expected: – The initial autonomic storm should be managed with nitroprusside and esmolol – The subsequent collapse should be treated with noradrenaline and/or vasopressin – Bradycardia will be resistant to atropine (no vagus to block); catecholamines or pacing will be required -Though they do not make a direct statement to this effect, ANZICS tacitly support CPR in the brain-dead organ donor; „cardiopulmonary resuscitation may result in recovery of cardiac function and successful transplantation”. […] Though they do not make a direct statement to this effect, ANZICS tacitly support CPR in the brain-dead organ donor; „cardiopulmonary resuscitation may result in recovery of cardiac function and successful transplantation”.

• #19 Care for the brain-dead organ donor | Deranged Physiology

  https://derangedphysiology.com/main/required-reading/organ-and-tissue-donation/Chapter-615/care-brain-dead-organ-donor

  Care of the patient preparing for organ donation after brain death is essentially the support of organ systems which have lost central autonomic and endocrine regulation. The intensivist must step in to the role of the pituitary and hypothalamus, making gross adjustments to parameters which were previously handled by this apparatus. This support consists of pituitary hormone replacement and support of the functions which were formerly performed by the autonomic nervous system. Aggressive support in general (including CPR) is justified on the grounds of it being the fulfilment of the patient’s wishes, who presumably would have supported any measures which facilitate their incredibly generous act. […] The circuit should be humidified. Normoxia and normocapnea must be maintained. There will be periodic requests for ABGs on 100% FiO2 from the donor coordinator, but afterwards the FiO2 must be minimised to prevent oxidative stress damage to the lungs. Haemodynamic instability is to be expected: – The initial autonomic storm should be managed with nitroprusside and esmolol – The subsequent collapse should be treated with noradrenaline and/or vasopressin – Bradycardia will be resistant to atropine (no vagus to block); catecholamines or pacing will be required -Though they do not make a direct statement to this effect, ANZICS tacitly support CPR in the brain-dead organ donor; „cardiopulmonary resuscitation may result in recovery of cardiac function and successful transplantation”. […] Though they do not make a direct statement to this effect, ANZICS tacitly support CPR in the brain-dead organ donor; „cardiopulmonary resuscitation may result in recovery of cardiac function and successful transplantation”.

• #20 Care for the brain-dead organ donor | Deranged Physiology

  https://derangedphysiology.com/main/required-reading/organ-and-tissue-donation/Chapter-615/care-brain-dead-organ-donor

  Care of the patient preparing for organ donation after brain death is essentially the support of organ systems which have lost central autonomic and endocrine regulation. The intensivist must step in to the role of the pituitary and hypothalamus, making gross adjustments to parameters which were previously handled by this apparatus. This support consists of pituitary hormone replacement and support of the functions which were formerly performed by the autonomic nervous system. Aggressive support in general (including CPR) is justified on the grounds of it being the fulfilment of the patient’s wishes, who presumably would have supported any measures which facilitate their incredibly generous act. […] The circuit should be humidified. Normoxia and normocapnea must be maintained. There will be periodic requests for ABGs on 100% FiO2 from the donor coordinator, but afterwards the FiO2 must be minimised to prevent oxidative stress damage to the lungs. Haemodynamic instability is to be expected: – The initial autonomic storm should be managed with nitroprusside and esmolol – The subsequent collapse should be treated with noradrenaline and/or vasopressin – Bradycardia will be resistant to atropine (no vagus to block); catecholamines or pacing will be required -Though they do not make a direct statement to this effect, ANZICS tacitly support CPR in the brain-dead organ donor; „cardiopulmonary resuscitation may result in recovery of cardiac function and successful transplantation”. […] Though they do not make a direct statement to this effect, ANZICS tacitly support CPR in the brain-dead organ donor; „cardiopulmonary resuscitation may result in recovery of cardiac function and successful transplantation”.

• #21 Brain death | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/brain-death

  Brain death occurs when a critically ill person dies sometime after being placed on life support. […] In some cases, a person who is brain dead may be a candidate for organ donation. […] Brain death is not the same as coma, because someone in a coma is unconscious but still alive. […] Brain death occurs when a critically ill patient dies sometime after being placed on life support. […] Because life support machines maintain the person’s breathing and heart rate, they are warm to the touch. This gives the illusion that the person is still alive. […] It is important for the medical staff members to fully explain that brain death is final, and that the person is dead and has no chance of ever regaining consciousness again. […] In some cases, a person who is brain dead may be a candidate for organ donation.

• #22 An ICU Nurse Discusses Brain Death – The Hastings Center

  https://www.thehastingscenter.org/1488-2/

  Brain death is an immensely challenging concept to grasp, even for health care providers. […] For seasoned ICU nurses, caring for these patients often elicits feelings of moral distress and inner conflict. […] Caring for a brain dead patient is incredibly mentally taxing, even when the family is in complete understanding. […] When a family is in denial, the distress felt by the health care provider is exponentially increased. […] We are prolonging the suffering of the McMath family by continuing to ventilate Jahis body. […] It is our duty as providers to ensure that the messages being portrayed to the public about Jahis case are abundantly clear. […] We do the general public (our patients) a disservice by perpetuating misconceptions about the finality of brain death. […] I would argue that continuing ventilatory support is prolonging the suffering of the McMath family, contributing to the general publics confusion surrounding brain death, and significantly contributing to the moral distress of Jahis providers.

• #23

  https://journals.lww.com/nams/fulltext/2018/07030/the_nursing_challenges_of_caring_for_brain_dead.5.aspx

  The process of caring for brain-dead patients was not merely limited to the patients but also included meeting the special needs of patients’ significant others experiencing a clinically critical, complex, and stressful situation which made it really stressful to break this bad news to them. […] Majority of families are not well informed about brain death, and this exacerbates the tension of breaking the brain-death news to patient’s family. […] The last theme was nurses’ feeling of lack of support and protection by the healthcare system. […] The results of this study revealed that nurses caring for brain-dead patients are facing numerous care challenges, so nursing authorities should pay more attention to the needs of nurses, plan necessary changes, and provide organizational support for them.

• #24 Brain Death & Donation after Circulatory Death — LifeSource

  https://www.life-source.org/partners/hospitals/brain-death/

  Brain death is the irreversible cessation of all brain activity, including the brain and brain stem. The brain dies from lack of blood/oxygenation. Brain death is death. […] The health care team’s key role is to help the family understand brain death and end of life decisions, and support the family. Families will be provided the amount of time they need to say goodbye to their loved one. […] The key role of LifeSource staff is to help the family understand donation opportunities. […] It is important for families to understand that their loved one has died before donation discussions take place. […] If you remember one thing, remember that organs are only ever recovered from deceased patients. This is important for you to remember because if you’ve never been involved in a recovery before, it may be unsettling. Brain dead patients also sometimes experience spinal reflexes, which originate from the spinal nerves, not the brain or brainstem. This means that healthcare professionals and families may see some movement of extremities. This should not be confused with brain activity.

• #25 Families Understanding Brain Death | Donor Network of Arizona

  https://www.dnaz.org/partners/hospital/brain-death/

  Families Understanding Brain Death The concept of brain death is difficult for many families to comprehend. However, it is important for families to understand their loved one is dead before conversations about organ, eye and tissue donation occur. The following communication points may be useful in helping families understand brain death. […] After declaration, refer to brain death as death, and tell the family the time of death. The patient is not in a coma. Refer to the ventilator and intravenous medications as artificial or mechanical support. […] Use the word death. Avoid commonly used euphemisms (e.g. passed away, gone, expired) in your conversation about the death. […] Encourage the family to ask questions and express their understanding of their loved ones death. Allow moments of silence. Try not to fill in gaps in conversation with meaningless words or explanations. […] When feasible, allow the family to observe parts of the neurological exams. Explain the medical equipment and its function in the care of their loved one.

• #26 How Should Clinicians Respond When Patients’ Loved Ones Do Not See “Brain Death” as Death? | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/how-should-clinicians-respond-when-patients-loved-ones-do-not-see-brain-death-death/2020-12

  Religious or cultural values sometimes conflict with medical standards of practice or law. […] As the rabbi of a large medical center with a significant Orthodox Jewish population, I have frequently supported both Orthodox families and our medical staffs attempts to sensitively navigate brain death diagnosis, which isnt accepted as the definition of death by many Orthodox Jews. […] By listening, engaging religious leadership, supporting hospital staff, and practicing cultural humility, clinicians can often identify a care plan for patients who are brain dead that is sensitive to both medical standards of practice and personal religious and cultural values. […] The family should continue to be listened to and shown compassion. […] It is crucial for medical practitioners to establish a collaborative, trusting relationship with the familys rabbinic leadership.

• #27

  https://journals.lww.com/nams/fulltext/2018/07030/the_nursing_challenges_of_caring_for_brain_dead.5.aspx

  Caring for brain-dead patients is one of the hardest duties for nurses, particularly in Intensive Care Units (ICUs). […] This study aimed to explore the nursing challenges of caring for patients diagnosed with brain death. […] Seven themes were extracted from the data: uncertainties and conflicts between physicians and nurses, tensions in breaking the news of patient’s brain death to families, stressful experience of caring for the first time, nurses’ physical and psychological afflictions due to complex care tensions, stress of being blamed by patients’ family, difficulty in tackling the emotions of patients’ family, and finally, a sense of lack of support and protection in care. […] Since nurses confront chain of tensions while caring for a brain-dead patient, this can affect the quality of this vital role to keep the transplantable organs viable; furthermore, authorities should implement special support programs for nurses.

• #28 Explaining nurses’ experiences of caring for brain dead patients: a content analysis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6122867/

  In order to achieve such a goal, nurses real experiences in this difficult situation should be taken into account. […] The majority of nurses believe they do not have the training required to provide the correct care for organ donor patients. […] The susceptibility of patients in the ICU, exposure to critical situations, and the high anxiety of relatives of patients while seeing their vulnerable loved ones, have made nursing to be considered as a complex care and the heaviest of duties for nurses in the ICU. […] Therefore, it is recommended to the educational system of universities and medical centers to provide training and supportive plans for the process of caring for brain-dead patients and organ donation in all dimensions, to increase the knowledge in this regard by considering nurses psychological and emotional demands.

• #29 The Nursing Challenges of Caring for Brain-dead Patients: A Qualitative Study

  https://nmsjournal.kaums.ac.ir/article_128907.html

  Caring for braindead patients is one of the hardest duties for nurses, particularly in Intensive Care Units (ICUs). […] This study aimed to explore the nursing challenges of caring for patients diagnosed with brain death. […] Seven themes were extracted from the data: uncertainties and conflicts between physicians and nurses, tensions in breaking the news of patients brain death to families, stressful experience of caring for the first time, nurses physical and psychological afflictions due to complex care tensions, stress of being blamed by patients family, difficulty in tackling the emotions of patients family, and finally, a sense of lack of support and protection in care. […] Since nurses confront chain of tensions while caring for a braindead patient, this can affect the quality of this vital role to keep the transplantable organs viable; furthermore, authorities should implement special support programs for nurses.

• #30 Brain Dead Pt Nursing DX – General Nursing Support

  https://allnurses.com/brain-dead-pt-nursing-dx-t358179/

  Just had a question about nursing diagnosis for a brain dead patient. Please check if my nursing dx sounds ok..I’m not quite sure. […] My patient suffered severe brain injury d/t MVA = epidural, subdural, subarachnoid hematoma, tentorial shift. Was pronounced brain dead. Family agreed for organ donation. […] 1) Ineffective airway clearance r/t absent cough, gag reflex, brain death aeb adventitious lung sounds(interventions: suctioning, auscultating, etc) […] 2) Decreased cardiac output r/t intracranial hemorrhage, hematoma? aeb declining BP, increased heart rate (interventions: giving meds like Dopamine, Neosynephrine as ordered to preserve organs for transplant, etc) […] Is the brain death patient being comfort cared or are they still keeping life support? […] But you could use impaired gas exchange r/t need respiratory ventilation. Potential for hemodynamic instability r/t multisystem organ failure.

• #31 Brain Dead Pt Nursing DX – General Nursing Support

  https://allnurses.com/brain-dead-pt-nursing-dx-t358179/

  By the way comfort care is not an potent dx if brain death has been declared. There is no need for pain meds or sedation, the pt is dead (brain dead is dead is dead). […] Isn’t brain death a medical diagnosis? If so, I don’t think that in itself can be included in the nursing diagnosis–you can’t „fix” brain death. But, you can help with comfort measures such as suctioning, etc. […] 1. Ineffective Tissue Perfusion (Cardiopulmonary) r/t decreased circulating blood volume aeb death resulting from compression of vital areas within the brainstem that control respiratory, vasomotor, and cardiac function. […] 2. Decreased Cardiac Output r/t altered stroke volume aeb arrhythmias (tachycardia), decreased BP, cold, clammy skin, decreased peripheral pulses, pale, grayish color of skin, and adventitious lung sounds in RLL and LLL.

• #32 Brain Dead Pt Nursing DX – General Nursing Support

  https://allnurses.com/brain-dead-pt-nursing-dx-t358179/

  By the way comfort care is not an potent dx if brain death has been declared. There is no need for pain meds or sedation, the pt is dead (brain dead is dead is dead). […] Isn’t brain death a medical diagnosis? If so, I don’t think that in itself can be included in the nursing diagnosis–you can’t „fix” brain death. But, you can help with comfort measures such as suctioning, etc. […] 1. Ineffective Tissue Perfusion (Cardiopulmonary) r/t decreased circulating blood volume aeb death resulting from compression of vital areas within the brainstem that control respiratory, vasomotor, and cardiac function. […] 2. Decreased Cardiac Output r/t altered stroke volume aeb arrhythmias (tachycardia), decreased BP, cold, clammy skin, decreased peripheral pulses, pale, grayish color of skin, and adventitious lung sounds in RLL and LLL.

• #33 Brain Dead Pt Nursing DX – General Nursing Support

  https://allnurses.com/brain-dead-pt-nursing-dx-t358179/

  The reason why I’m suggesting these nursing diagnoses is because of the fact that your patient was declared brain dead and was going to be an organ donor. […] It is very important to make your symptoms specific to your patient. For you will use these later on to evaluate your patients progress and to determine whether to continue with the current plan of care or revise it. […] don’t forget safety, love and belonging needs of the family like grieving.

• #34 Learning Center

  https://www.neurocriticalcare.org/NCS-Learning-Center/Learning-Center/Results/Details/brain-death-toolkit

  The Brain Death Toolkit includes a variety of helpful resources and educational offerings, including instructional videos and web-based courses. […] It also provides a sample brain death policy and checklist, which may be used as a template for adoption at individual institutions/hospitals. […] We provide resources to explain the pitfalls and challenges in brain death determination, and have also included Frequently Asked Questions (FAQs), both for medical practitioners and the general public. […] This content was developed by the NCS Brain Death Task Force as an educational tool and not as a guideline or a policy. […] Practitioners should refer to local ordinances that apply to the diagnosis of death in the regions in which they practice.

• #35 Brain Death and Donation – LifeShare University

  https://www.lifeshareuniversity.org/brain-death-and-donation.html

  Brain Death and Donation Orientation Video […] Staff responsibilities vary depending on hospital protocols, the individuals involved and the needs of the family. Here are some general guidelines: […] Physician declares patients brain death. […] Nurse provides ongoing care to families throughout the patients hospitalization. […] The needs and wishes of the patients family are always kept in focus by the medical team, by the LifeShare staff members and by social workers and clergy. […] Brain death is death and is irreversible. […] Meanwhile at the hospital, the donor is maintained on artificial support and the condition of each organ is carefully monitored by LifeShare. […] Organs are recovered to ultimately give life to patients in need. Through organ donation by brain death, as many as eight lives can be saved with one patients gift.

• #36 Devastating Brain Injuries: Assessment and Management Part I: Overview of Brain Death – The Western Journal of Emergency Medicine

  https://westjem.com/articles/devastating-brain-injuries-assessment-and-management-part-i-overview-of-brain-death.html

  To establish a diagnosis of brain death, the clinician must first identify the underlying causes and determine that they are irreversible. […] The patient should have a pCO2 within the normal range and be pre-oxygenated with 100% FiO2. […] The goal prior to and after the determination of brain death is to maintain perfusion of vital organs. […] Recently, studies have proven that aggressive donor management (ADM) can improve the quantity and quality of donated organs from brain dead donors. […] The active participation of all healthcare providers involved in the care of patients with severe neurologic insults preserves the option of organ donation for patients and their families. […] It is imperative to explicitly state that the primary purpose is not to improve the number of organs that can be transplanted, as this would represent a potential conflict of interest for the physician caring for the injured patient. […] If a patient does regress to brain death, organ perfusion will be maintained should the patients family decide to donate.

• #37 Devastating Brain Injuries: Assessment and Management Part I: Overview of Brain Death – The Western Journal of Emergency Medicine

  https://westjem.com/articles/devastating-brain-injuries-assessment-and-management-part-i-overview-of-brain-death.html

  To establish a diagnosis of brain death, the clinician must first identify the underlying causes and determine that they are irreversible. […] The patient should have a pCO2 within the normal range and be pre-oxygenated with 100% FiO2. […] The goal prior to and after the determination of brain death is to maintain perfusion of vital organs. […] Recently, studies have proven that aggressive donor management (ADM) can improve the quantity and quality of donated organs from brain dead donors. […] The active participation of all healthcare providers involved in the care of patients with severe neurologic insults preserves the option of organ donation for patients and their families. […] It is imperative to explicitly state that the primary purpose is not to improve the number of organs that can be transplanted, as this would represent a potential conflict of interest for the physician caring for the injured patient. […] If a patient does regress to brain death, organ perfusion will be maintained should the patients family decide to donate.

• #38 Families Understanding Brain Death | Donor Network of Arizona

  https://www.dnaz.org/partners/hospital/brain-death/

  Families Understanding Brain Death The concept of brain death is difficult for many families to comprehend. However, it is important for families to understand their loved one is dead before conversations about organ, eye and tissue donation occur. The following communication points may be useful in helping families understand brain death. […] After declaration, refer to brain death as death, and tell the family the time of death. The patient is not in a coma. Refer to the ventilator and intravenous medications as artificial or mechanical support. […] Use the word death. Avoid commonly used euphemisms (e.g. passed away, gone, expired) in your conversation about the death. […] Encourage the family to ask questions and express their understanding of their loved ones death. Allow moments of silence. Try not to fill in gaps in conversation with meaningless words or explanations. […] When feasible, allow the family to observe parts of the neurological exams. Explain the medical equipment and its function in the care of their loved one.

• #39 FF #479 – Communicating About Death by Neurologic Criteria | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/communicating-about-death-by-neurologic-criteria/

  Background: Death by neurologic criteria (DNC) is the complete and permanent loss of all functions of the entire brain and brainstem due to catastrophic brain injury. […] DNC can be confusing to both families and clinicians which heightens the need for ongoing and meticulous communication. […] Families should be counseled in advance regarding the potential for spinal reflex movements including fasciculations, facial myokymia (fine, quivering movements), myoclonus, plantar withdrawal, respiratory-like movements, head turning, leg movements mimicking periodic leg movements, and the Lazarus sign. […] Upon determination of DNC, families should be plainly told the patient has died and provided with an official date and time of death. […] Communication around DNC differs from many other serious illness conversations in that the focus is on the sharing of difficult news and the timing of stopping organ-support, rather than on conducting a goals of care discussion focused on a patient’s values and preferences.

• #40 FF #479 – Communicating About Death by Neurologic Criteria | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/communicating-about-death-by-neurologic-criteria/

  Background: Death by neurologic criteria (DNC) is the complete and permanent loss of all functions of the entire brain and brainstem due to catastrophic brain injury. […] DNC can be confusing to both families and clinicians which heightens the need for ongoing and meticulous communication. […] Families should be counseled in advance regarding the potential for spinal reflex movements including fasciculations, facial myokymia (fine, quivering movements), myoclonus, plantar withdrawal, respiratory-like movements, head turning, leg movements mimicking periodic leg movements, and the Lazarus sign. […] Upon determination of DNC, families should be plainly told the patient has died and provided with an official date and time of death. […] Communication around DNC differs from many other serious illness conversations in that the focus is on the sharing of difficult news and the timing of stopping organ-support, rather than on conducting a goals of care discussion focused on a patient’s values and preferences.

• #41 Brain Death-Do not Resuscitate-End-of-life Care: A Literature Review | Biores Scientia

  https://bioresscientia.com/article/brain-death-do-not-resuscitate-end-of-life-care-a-literature-review

  Because of the complexity of end-of-life care, it is necessary to conduct an initial bio-psychosocial-spiritual assessment from the perspective of a multidisciplinary team. […] Overall, healthcare professionals face ethical dilemmas when deciding whether to withhold treatment is appropriate. […] The ethical dilemmas surrounding withholding treatment in end-of-life patients require a delicate balance between autonomy, beneficence and non-maleficence. Collaboration and compassionate communication are critical to navigating these complex decisions. […] Intensive Care Unit health professionals play a key role in the care of patients at the end of their lives. The support they provide both to the patients themselves and to their families is not only physical but also emotional. The approach of each health professional to this condition affects the degree of palliative care at the end of the patients’ life. Improving the quality of end-of-life care is critical to ensuring patient-centered care and support for patients and their families during this difficult time.

• #42 An ICU Nurse Discusses Brain Death – The Hastings Center

  https://www.thehastingscenter.org/1488-2/

  Brain death is an immensely challenging concept to grasp, even for health care providers. […] For seasoned ICU nurses, caring for these patients often elicits feelings of moral distress and inner conflict. […] Caring for a brain dead patient is incredibly mentally taxing, even when the family is in complete understanding. […] When a family is in denial, the distress felt by the health care provider is exponentially increased. […] We are prolonging the suffering of the McMath family by continuing to ventilate Jahis body. […] It is our duty as providers to ensure that the messages being portrayed to the public about Jahis case are abundantly clear. […] We do the general public (our patients) a disservice by perpetuating misconceptions about the finality of brain death. […] I would argue that continuing ventilatory support is prolonging the suffering of the McMath family, contributing to the general publics confusion surrounding brain death, and significantly contributing to the moral distress of Jahis providers.

• #43 How Should Clinicians Respond When Patients’ Loved Ones Do Not See “Brain Death” as Death? | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/how-should-clinicians-respond-when-patients-loved-ones-do-not-see-brain-death-death/2020-12

  Some hospital staff members might become distressed by the prospect of continuing interventions for a body that they consider to be a corpse. […] For those remaining on the care team, it becomes essential to reiterate the importance of cultural humility and the fact that defining life and death are philosophical concepts, not just medical criteria. […] While decisions are made on a case-by-case basis, taking various crucial details into account, most rabbinic leaders are reasonable and can help find a workable approach. […] This approach often allows families to feel less culpable in their loved ones death and that they have maintained their integrity in adhering to Jewish law while caring for a family member. […] If compassion, trust, and a positive working relationship have been established from the outset, conflict is much more likely to be mitigated than in situations when that relationship has not been developed.

• #44 How Should Clinicians Respond When Patients’ Loved Ones Do Not See “Brain Death” as Death? | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/how-should-clinicians-respond-when-patients-loved-ones-do-not-see-brain-death-death/2020-12

  Some hospital staff members might become distressed by the prospect of continuing interventions for a body that they consider to be a corpse. […] For those remaining on the care team, it becomes essential to reiterate the importance of cultural humility and the fact that defining life and death are philosophical concepts, not just medical criteria. […] While decisions are made on a case-by-case basis, taking various crucial details into account, most rabbinic leaders are reasonable and can help find a workable approach. […] This approach often allows families to feel less culpable in their loved ones death and that they have maintained their integrity in adhering to Jewish law while caring for a family member. […] If compassion, trust, and a positive working relationship have been established from the outset, conflict is much more likely to be mitigated than in situations when that relationship has not been developed.

• #45 How Should Clinicians Respond When Patients’ Loved Ones Do Not See “Brain Death” as Death? | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/how-should-clinicians-respond-when-patients-loved-ones-do-not-see-brain-death-death/2020-12

  This case illustrates how culture or religion might countermand a physicians diagnosis, even regarding death. […] The challenge is whether a health care institution can remain true to its commitment to evidence-based practice while respecting patients right to allow their cultural values to play a determining role in their lives. […] Cultural competency, which emerged from the nursing profession, is now an established element of modern medicine. […] The brain death debate is arguably the most contentious and the most discussed topic in contemporary Jewish medical ethics. […] I propose that institutions respond to DNC denial by convening, from the moment of its discovery, a forum for communication with the family that is serious, transparent, and ongoing. […] The FLC would orchestrate the patients treatment accordingly. […] The FLC allows the attending physician to focus on the diagnosis, and if a family rejects the DNC determination, another group assumes the negotiation task on behalf of the institution.

• #46 How Should Clinicians Respond When Patients’ Loved Ones Do Not See “Brain Death” as Death? | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/how-should-clinicians-respond-when-patients-loved-ones-do-not-see-brain-death-death/2020-12

  Some hospital staff members might become distressed by the prospect of continuing interventions for a body that they consider to be a corpse. […] For those remaining on the care team, it becomes essential to reiterate the importance of cultural humility and the fact that defining life and death are philosophical concepts, not just medical criteria. […] While decisions are made on a case-by-case basis, taking various crucial details into account, most rabbinic leaders are reasonable and can help find a workable approach. […] This approach often allows families to feel less culpable in their loved ones death and that they have maintained their integrity in adhering to Jewish law while caring for a family member. […] If compassion, trust, and a positive working relationship have been established from the outset, conflict is much more likely to be mitigated than in situations when that relationship has not been developed.

• #47 Devastating Brain Injuries: Assessment and Management Part I: Overview of Brain Death – The Western Journal of Emergency Medicine

  https://westjem.com/articles/devastating-brain-injuries-assessment-and-management-part-i-overview-of-brain-death.html

  To establish a diagnosis of brain death, the clinician must first identify the underlying causes and determine that they are irreversible. […] The patient should have a pCO2 within the normal range and be pre-oxygenated with 100% FiO2. […] The goal prior to and after the determination of brain death is to maintain perfusion of vital organs. […] Recently, studies have proven that aggressive donor management (ADM) can improve the quantity and quality of donated organs from brain dead donors. […] The active participation of all healthcare providers involved in the care of patients with severe neurologic insults preserves the option of organ donation for patients and their families. […] It is imperative to explicitly state that the primary purpose is not to improve the number of organs that can be transplanted, as this would represent a potential conflict of interest for the physician caring for the injured patient. […] If a patient does regress to brain death, organ perfusion will be maintained should the patients family decide to donate.

• #48 Nursing Considerations with Brain Death – FRESHRN

  https://www.freshrn.com/season-4-episode-2-nursing-considerations-with-brain-death-and-organ-procurement-show-notes/

  Nursing Considerations with Brain Death and Organ Procurement […] What is brain death and how do you respond to it? […] You cannot deny a patient or family member the chance to donate their organs. […] Its not up to you as a nurse to decide if their injuries make them a candidate for donation. […] Brain Death Definition: According to the National Institute of Health, brain death is the irreversible loss of all functions of the brain including the brain stem. […] It can be tough for family members to see the blood pressure still working and the heart still beating and understand that they are technically dead brain dead. […] There is absolutely no medication or sedation that can be happening during the brain death test. […] If you think the patient is brain dead and there will be tests to verify, the family should be prepared. […] Talk about brain function. In a coma, there is brain function. In brain death, there is not. […] Legally, they are dead. (In most, if not all states)

• #49 Explaining nurses’ experiences of caring for brain dead patients: a content analysis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6122867/

  In order to achieve such a goal, nurses real experiences in this difficult situation should be taken into account. […] The majority of nurses believe they do not have the training required to provide the correct care for organ donor patients. […] The susceptibility of patients in the ICU, exposure to critical situations, and the high anxiety of relatives of patients while seeing their vulnerable loved ones, have made nursing to be considered as a complex care and the heaviest of duties for nurses in the ICU. […] Therefore, it is recommended to the educational system of universities and medical centers to provide training and supportive plans for the process of caring for brain-dead patients and organ donation in all dimensions, to increase the knowledge in this regard by considering nurses psychological and emotional demands.

• #50

  https://journals.lww.com/jnnonline/abstract/1987/02000/brain_death__nursing_roles_and_responsibilities.8.aspx

  Nurses working in an intensive care setting must be knowledgeable about the diagnosis of brain death and its ramifications to care competently for the patient and family. […] The neuroscience nurse’s responsibilities include meeting the patient’s physical needs and identifying the family’s needs and teaching them about brain death. […] Not fulfilling these responsibilities could result in dysfunctional grieving for the family and loss of a potential organ donor.

• #51

  https://www.nursingcenter.com/journalarticle?Article_ID=5288681&Journal_ID=54030&Issue_ID=5288581

  During brain death testing and for a certain period following a brain death declaration, the brain-dead patient continues to receive intensive nursing and medical care, similar to the care provided prior to the brain death declaration. […] Families may also object on moral or religious grounds to the diagnosis of death by neurologic criteria. […] Nurses are well positioned to identify conflict in its early stages and to recommend such intervention. […] While brain death testing of children is similar to that of adults, nurses working in pediatric settings should be aware of the variations. […] Depending on the clinical circumstances, some patients who have been declared brain dead are eligible for organ donation. […] Nurses may face additional ethical challenges when caring for patients declared brain dead.

• #52 Study Finds Training Medical Students to Evaluate & Discuss Brain Death Improves Care & Communication | NYU Langone News

  https://nyulangone.org/news/study-finds-training-medical-students-evaluate-discuss-brain-death-improves-care-communication

  Comfort with both performing a brain death evaluation and talking to a family member about brain death improved significantly after the session. […] Combining teaching with simulation and adding actors to portray family members can significantly improve a medical students knowledge and comfort with determining brain death, Dr. Lewis says.

• #53 Learning Center

  https://www.neurocriticalcare.org/NCS-Learning-Center/Learning-Center/Results/Details/brain-death-determination-course

  While there exists a legal provision for brain death, or death by neurologic criteria (BD/DNC), institutional protocols for diagnosis are not universal and are often absent; no specific criteria for diagnosis is mandated. […] The Brain Death Determination on-line course, presented by the Neurocritical Care Society, aims to standardize the process of brain death diagnosis. […] Highlighting the necessary steps that must be taken to determine brain death. […] Reviewing meticulous examination methods, including apnea testing, understanding the role of ancillary testing, and discussing proper documentation. […] Outlining helpful communication approaches with fellow providers and patient families. […] Describing common pitfalls and barriers that may arise during the determination process.

• #54 Study Finds Training Medical Students to Evaluate & Discuss Brain Death Improves Care & Communication | NYU Langone News

  https://nyulangone.org/news/study-finds-training-medical-students-evaluate-discuss-brain-death-improves-care-communication

  Comfort with both performing a brain death evaluation and talking to a family member about brain death improved significantly after the session. […] Combining teaching with simulation and adding actors to portray family members can significantly improve a medical students knowledge and comfort with determining brain death, Dr. Lewis says.

• #55 Updated Brain Death Guidance: What Care Teams Need to Know | SCCM

  https://www.sccm.org/communications/sccm-podcast/sccm-podcast-all-episodes/sccm-pod-533-ccm-updated-brain-death-guidance-what-critical-care-teams-need-to-know

  However, you do not need to obtain consent for doing the evaluation, that we have an obligation as clinicians to know whether the patient who we are taking care of in front of us is alive or dead. […] The clinician at the bedside also always has the option to say, in this patient, because of the severity of their cardiopulmonary disease, I do not feel that it is safe in order to proceed with the apnea test. […] If you are going to use ancillary testing, prior to doing that ancillary testing, you must confirm that the entire neurologic exam that you are able to do has been performed and all the findings are consistent with brain death. […] Hospitals need to take the guidelines and they need to revise their institutional protocols to be consistent with the guidelines, keeping in mind state and local laws and regulations that also need to be adhered to. […] Checklists are vital in this domain, right? This is an area where we’ve got to be 100% right 100% of the time.

• #56 How Educators Can Help Prevent False Brain Death Diagnoses | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/how-educators-can-help-prevent-false-brain-death-diagnoses/2020-12

  The case illustrates a series of errors that led to a false determination of brain death. […] Without the safety net of standardized guidelines, false diagnoses of brain death are more likely to occur. […] Undergraduate and graduate medical education, as well as continuing medical education, should include instruction on the disorders of consciousnessbrain death, coma, vegetative state, and minimally conscious state. […] The Neurocritical Care Society provides a brain death determination course to standardize brain death diagnosis.

• #57 Learning Center

  https://www.neurocriticalcare.org/NCS-Learning-Center/Learning-Center/Results/Details/brain-death-determination-course

  While there exists a legal provision for brain death, or death by neurologic criteria (BD/DNC), institutional protocols for diagnosis are not universal and are often absent; no specific criteria for diagnosis is mandated. […] The Brain Death Determination on-line course, presented by the Neurocritical Care Society, aims to standardize the process of brain death diagnosis. […] Highlighting the necessary steps that must be taken to determine brain death. […] Reviewing meticulous examination methods, including apnea testing, understanding the role of ancillary testing, and discussing proper documentation. […] Outlining helpful communication approaches with fellow providers and patient families. […] Describing common pitfalls and barriers that may arise during the determination process.

• #58 Nursing care to patients in brain death and potential organ donors – Acta Paulista de Enfermagem

  https://acta-ape.org/en/article/nursing-care-to-patients-in-brain-death-and-potential-organ-donors/

  Nursing care to patients in brain death and potential organ donors. […] Analyzing the opinion of nurses about nursing care to patients with brain death and potential organ donors. […] The dimensions of the nursing care to potential donors of organs and tissues give indications of a practice focused on maintaining hemodynamic, also with the presence of the conflict between assisting patients with brain death or others with possibilities of survival. […] The nursing care to potential organ donors is a complex process and requires better skills and emotional maturity, which are not always present.

• #59 Medical Management of Brain-Dead Organ Donors

  https://www.accjournal.org/journal/view.php?doi=10.4266/acc.2019.00430

  The management of a brain-dead organ donor is very challenging. To achieve this goal, adequate fluid resuscitation, intense vasoactive medication, immunosuppressive therapy, and sufficient hemodynamic, and physiological monitoring are required. […] The protocol we have proposed and provided in the checklist may help intensivists manage brain-dead organ donors to promote successful organ and tissue donations.

• #60 Care of brain dead | PPT

  https://www.slideshare.net/slideshow/care-of-brain-dead/160584146

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