Brain Death and Organ Donation

Jessica Hammond, RN, BSN, SRNA

Topics for DiscussionHistory of the determination of death

Assessment and testing of the potential brain dead patient

Medical management of the brain dead organ donor

Organ procurement surgery

Anesthesia management for organ procurement surgery

Organ procurement as portrayed by the media

Determining Death- The Historical Perspective

American Academy of Neurology Practice Parameter of 1995

So what is the process of determining brain death?

Clinical Evaluation:Prerequisites

Establish irreversible and proximate cause of coma

Achieve normal core temperature

Achieve normal systolic blood pressure

Perform one neurologic examination

Clinical Evaluation: Neurologic Assessment

Clinical Evaluation: Apnea Test

Confirmatory Testing:Nuclear Brain Scanning

Confirmatory Testing:Angiography

Confirmatory Testing:Transcranial Doppler Ultrasonography

Confirmatory Testing:Electroencephalography (EEG)

Certification of DeathThe medical record must indicate:

etiology and irreversibility of coma / unresponsiveness

absence of motor response to painabsence of brainstem reflexes during two separate

examinations separated by at least 6 hoursabsence of respiration with pCO2 ≥ 60 mm hg justification for, and result of, confirmatory tests if

used

AAN Practice Parameter 2010 Update

Medical Management of the Brain Dead Donor

Physiologic Changes Following Brain Death

Shift in Care

Goals of Donor

Management

Timing and Coordination

Surgical Procedure-

Organ Procurement

Surgery for Organ Procurement:

Current Anesthesia Recommendations

Do volatile anesthetics have a place in procurement surgeries??

Life is pleasant.Death is peaceful.

It’s the transition that’s troublesome.

Isaac Asimov