ICU · Ethics
Brain death and organ donation in ICU
Also known as Brain death · Brainstem death · Organ donation · Donation after brain death · DBD · Donation after circulatory death · DCD
Brain death: irreversible cessation of all brain function (cerebrum + brainstem). LEGAL definition of death in most countries. Diagnosis: precondition (known cause, exclusion of reversible causes), clinical examination (fixed dilated pupils, absent corneal reflex, absent gag/cough, absent caloric response, apnoea test). Two doctors, two examinations (time interval varies by jurisdiction). Organ donation: DBD (donation after brain death — heart beating) or DCD (donation after circulatory death — controlled, after withdrawal of life-sustaining treatment). ICU management of brain-dead donor: maintain perfusion (MAP ≥65, vasopressors), normothermia, normoglycaemia, electrolytes, hormone resuscitation (vasopressin, T3/T4, insulin — controversial). R…
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Target exams
Red flags
- Brain death is LEGAL death — patient is DEAD (not dying). Documentation is critical
- Apnoea test: positive only when targets are reached — PaCO2 ≥60 mmHg AND pH below 7.30 — with NO respiratory effort (World Brain Death Project criteria)
- Maintain donor haemodynamics — hormonal resuscitation is associated with more organs transplanted per donor
- Refer to donation team EARLY (before withdrawal if DCD) — maximises organ utilisation
Meet the patient
A 54-year-old man, day three after an aneurysmal subarachnoid haemorrhage. Intubated, GCS 3, fixed dilated pupils, no cough on tracheal suctioning. The consultant wants to perform brainstem death tests this afternoon — but the core temperature is 34.2 degrees C and a thiopentone infusion is still running for intracranial pressure control.[1]
The two questions that decide the afternoon are the two that decide every brain-death determination: have I excluded every reversible mimic of death, and can I complete a valid clinical examination? Answer those in order and the rest is documentation.[1]
References18ShowHide
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- [18]Patel MS, Abt PL Current practices in deceased organ donor management Curr Opin Organ Transplant, 2019.PMID 31090647