Brain Death and Organ Donation Jessica Hammond, RN, BSN, SRNA

Topics for Discussion History 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 Death The medical record must indicate: etiology and irreversibility of coma / unresponsiveness absence of motor response to pain absence of brainstem reflexes during two separate examinations separated by at least 6 hours absence 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 Life is pleasant. Death is peaceful. It’s the transition that’s troublesome. Isaac Asimov