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

2. 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

3. Determining Death- The Historical Perspective

4. American Academy of Neurology Practice Parameter of 1995

5. So what is the process of determining brain death?

6. Clinical Evaluation: Prerequisites
Establish irreversible and proximate cause of coma
Achieve normal core temperature
Achieve normal systolic blood pressure
Perform one neurologic examination

7. Clinical Evaluation: Neurologic Assessment

8. Clinical Evaluation: Apnea Test

9. Confirmatory Testing: Nuclear Brain Scanning

10. Confirmatory Testing: Angiography

11. Confirmatory Testing: Transcranial Doppler Ultrasonography

12. Confirmatory Testing: Electroencephalography (EEG)

13. 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

14. AAN Practice Parameter 2010 Update

15. Medical Management of the Brain Dead Donor

16. Physiologic Changes Following Brain Death

17. Shift in Care

18. Goals of Donor Management

20. Timing and Coordination

21. Surgical Procedure- Organ Procurement

22. Surgery for Organ Procurement: Current Anesthesia Recommendations

24. Do volatile anesthetics have a place in procurement surgeries??

27. Life is pleasant. Death is peaceful
Life is pleasant. Death is peaceful. It’s the transition that’s troublesome.
Isaac Asimov