Medicines for Brain death

What it is

Brain death (also called death confirmed by neurological criteria) means that a person has died because their brain has permanently and irreversibly stopped functioning, including the parts of the brain that are essential for life, such as those that control breathing. It is a way of confirming that death has occurred in certain specific circumstances — particularly when a person is on a ventilator (a breathing machine) in intensive care after a catastrophic brain injury or illness. This is an important and sensitive concept: normally, we recognise death when the heart stops and breathing ceases; but in some situations, a person’s brain can be irreversibly damaged to the point that it has permanently stopped working, while machines (such as a ventilator) are artificially keeping the heart beating and oxygen flowing. In this situation, although the body may look as if it is still alive because of the machine, the person has died, because the brain — which is essential for life and for the person themselves — has irreversibly ceased to function. Brain death usually results from a severe brain injury or illness that causes catastrophic, irreversible damage — such as a severe head injury, a major bleed in or around the brain, a lack of oxygen to the brain, or other serious causes — where, despite treatment, the brain has been so severely damaged that it has stopped functioning and cannot recover. Confirming brain death is done carefully and rigorously, according to strict medical criteria and formal tests, carried out by senior doctors who are experienced and independent of any transplant considerations, to be certain that the brain has irreversibly stopped functioning and that there is no possibility of recovery. This is a profoundly difficult and painful situation for families, and they are supported with compassion, clear explanation, and time. Understanding brain death is also relevant to organ donation, as people confirmed to have died by these criteria may be able to donate organs if that is in line with their and their family’s wishes. The key messages are that brain death means a person has died because their brain has permanently and irreversibly stopped functioning (even if machines are keeping the heart and breathing going), that it is confirmed by careful, strict medical tests by experienced doctors, and that families are supported with compassion through this profoundly difficult situation.

How it is treated

Brain death is confirmed through a careful, rigorous, and strictly regulated process by experienced senior doctors, and families are supported with compassion, clear explanation, and time throughout this profoundly difficult situation. When a person has suffered a catastrophic brain injury or illness and is on a ventilator in intensive care, and there are signs that the brain may have irreversibly stopped functioning, the medical team assesses the situation carefully. Before any formal testing for brain death, certain conditions must be met to ensure the tests are valid — for example, being certain of the cause of the catastrophic brain damage, and ensuring that there are no other factors (such as certain medicines, or reversible conditions) that could be affecting the brain’s function or mimic brain death; the situation is assessed thoroughly. The confirmation of brain death is then made using strict, formal criteria and specific clinical tests, which check for the absence of brain function, including the brainstem functions that control vital reflexes and breathing; these tests are carried out by senior, experienced doctors (usually two, testing separately, and independent of any transplant team), following established guidelines, to be certain that the brain has irreversibly and permanently stopped functioning and that there is no possibility of recovery. This rigorous process ensures the diagnosis is made with certainty. Throughout, the family is central to the care: they are supported with compassion, kept informed with clear and honest explanation of what is happening and what the tests mean, given time, and supported by the team (including specialist staff) through this devastating experience; their questions are answered, and they are supported in understanding that, once brain death is confirmed, their loved one has died. The care team supports the family in the decisions and steps that follow. Organ and tissue donation may be discussed sensitively where relevant, as a person confirmed to have died by neurological criteria may be able to donate organs — this is approached carefully, in line with the person’s known wishes (including any registered decision) and with the family, by specialist staff, and separately from the confirmation of death. The overarching approach is one of rigorous, careful medical confirmation combined with compassionate, honest, and supportive care for the family. The key messages are that brain death is confirmed through a careful, strictly regulated process by experienced doctors to be certain the brain has irreversibly stopped functioning, that it means the person has died even though machines may be maintaining the heartbeat and breathing, and that families are supported with compassion, clear explanation, and time through this profoundly difficult situation — with organ donation discussed sensitively and according to wishes where relevant.