Ethical Dilemma or Medical Problem? An Emergency Department Approach to the Brain-Dead
Patient and Preservation of the Organ Donor
Organ supply is the greatest limitation to organ transplantation nowadays.
Among the factors that can affect organ supply favorably, donor management has received the least attention.
To meet the increased need for transplantable organs, medical staff should develop ways
for optimal recognition of maintenance of donors. With an increased awareness of the problems
and needs of the donor and the application of a rational physiological approach, the supply of
functional organs for transplantation can be boosted.
The importance of establishing an acceptable
method of rapidly and accurately determining brain death in potential donors cannot
be overemphasized. The organ transplantation community has invoked the Uniform
Determination of Death Act to informally establish the “Dead Donor Rule” which states that one can
only retrieve vital organs after the declaration of death.
The clinical evaluation comprise documenting the complete absence of function of
the entire brain and brainstem. This includes complete loss of consciousness,
no spontaneous movements, no reaction to stimuli, no function or reflexes of the cranial
nerves, and no spontaneous
breathing during apnea testing.
Five brain stem reflexes should be absent to diagnose brain stem death: pupillary light
response; corneal reflex to touch; vestibule-ocular reflex using the cold caloric test; the gag
reflex; and the apnoea test.
Transcranial Doppler (TCD) sonography demonstrates the cessation
of brain perfusion. These adjunctive studies may also comprise serial electroencephalography
(EEG) and radionuclide scan to evaluate cerebral blood flow
Emerg Med Open J. 2017; 3(2): e4-e6. doi: 10.17140/EMOJ-3-e004