How do they know if your brain stem has died?
The tests used to determine brain stem death are simple but conclusive. They will only be carried out after doctors have established that the patient has suffered irreversible brain damage.
Before the tests are started checks are made to make sure that any factors which might affect the tests such as drugs or an extremely low body temperature have been eliminated.
The tests are done at the patient’s bedside. First of all, a torch is shone into both eyes to see if the pupils react to the light. Then the cornea, which is normally ultra-sensitive, is stroked with a tissue or cotton wool. Next, painful pressure is applied to the forehead and the nose is pinched. Ice-cold water is then syringed into each ear in turn, which would normally cause eye movement. A tube is then inserted down the patient’s throat to provoke a gagging or coughing response.
Finally, and most importantly, conditions are created which allow the patient to be removed from the ventilator for a short period of about ten minutes to see if they show any sign of attempting to breathe on their own. Patients who are brain stem dead will not react in any way to any of the tests.
This group of tests is carried out twice, at separate times. They are done by two senior doctors with special expertise in this area, neither of whom must be a member of the transplant team.
If the second set of tests confirms no evidence of brain stem activity the patient is declared dead.
The standards for certifying death by brain stem death are strict and are accepted medically, legally and ethically in the UK and in most other countries in the world.
Organ and tissue donation – your questions answered
Transplants are one of the most miraculous achievements of modern medicine. But they depend entirely on the generosity of donors and their families who are willing to make this life-saving or life-enhancing gift to others.
One donor can save the life of several people, restore the sight of two others and improve the quality of life of many more. The more people who pledge to donate their organs and tissue after their death, the more people stand to benefit. By choosing to join the NHS Organ Donor Register you could help to make sure life goes on for many others.
Joining the register records your agreement to the use of your organs and tissue for transplantation after your death.
When you register it is important that you tell those closest to you about your decision.
To decide whether or not you wish to become a donor after you have died is something very personal and it is important that everyone makes their own decision. This booklet contains answers to the most commonly asked questions about organ and tissue donation and aims to resolve any doubts you might have about leaving a legacy of life for others after you die.
- What is organ donation?Organ donation is the gift of an organ to help someone who needs a transplant. The generosity of donors and their families enables over 3,000 people in the UK every year to take on a new lease of life.
- When were the first organ transplants?The first successful kidney transplant was in 1954. The first heart transplant took place in 1967.
- What organs can be transplanted?Kidneys, heart, liver, lungs, pancreas and the small bowel can all be transplanted.
Techniques are improving all the time and we may soon be able to transplant other parts of the body to help even more people.
- What is tissue donation?Tissue donation is the gift of tissue such as corneas, skin, bone, tendons, cartilage and heart valves to help others.
The first successful cornea transplant was in 1905. Every year thousands of people with a severe eye disease or injury have their sight restored by donated corneas.
Bone, tendons and cartilage are used for reconstruction after an injury or during joint replacement surgery. A bone transplant can prevent limb amputation in patients suffering from bone cancer.
Heart valves are used to help children born with heart defects and adults with diseased or damaged valves. Skin grafts are used to treat people with severe burns.
Most people can donate tissue. Unlike organs, it may be possible to donate tissue up to 48 hours after a person has died.
Some bare facts-
- Every hour 14 people are dying of road accidents in India. The total annual deaths due to road accidents has crossed 1.18 lakh in the year 2009, according to the National Crime Records Bureau (NCRB).
- Every year nearly 1.5 lakh new patients requiring kidney transplants are added to the inexhaustible patient numbers in need of kidney transplant.
- Majority of us do not have compatible and willing family donors. It means if one gets kidney failure it boils down to lifelong dialysis or transplant or an imminent death.
- The liver, lung and cardiac failure numbers are no less daunting.
- The economics of demand and supply is totally skewed. This encourages unethical practices in which the poor is coerced to sell one of his kidneys or a part of his liver. Besides exploitation of the poor there is sexual exploitation too. 85% recipients are males and 90% organ donors are females.
- In many developed nations the concept of implied consent is in place. Simplistically it means that the hospital will retrieve transplantable organs before declaring a brain stem dead person dead, unless the relatives explicitly forbid the organ retrieval.
What is the way out?
At societal level
- Multi pronged strategy to increase awareness among people about the facts of brain death. If a patient is brain dead then it is irreversible and final.
- Organ retrieval does not disfigure the body.
- No religion in the world forbids organ donation.
- By this noble and virtuous act by one family, at least half a dozen families get a new lease of life. What goes around comes back.
The society is as good or bad as its individual members. We reap tomorrow what we sow today.
At the level of the Government
- Simplifying and expediting the necessary permission to secondary and tertiary care hospitals to retrieve organs from brain dead person.
- Both the government and private hospitals should be incentivised /motivated to retrieve organs and transplant them by cutting the bureaucratic red tape.
- Government and private sector to commit financial support for economically challenged/ BPL persons to go for organ transplant.
- Help organ transplant to come out of the illegal cobwebs of brokers by making organ transplant laws more practical.
- Promote research in organ regenerative therapies and animal organ transplant into humans.
- Reduce cost of post transplant medicines.
At the level of Hospitals / Doctors
There should be a better interaction amongst different specialists in identifying a potential brain dead donor. Professional ego and inadequate incentivization should not come in way of active cadaver transplant service.
Dedicated social workers and transplant coordinators should be appointed in major hospitals to promote organ donation. They will have the necessary training to approach the distraught families with empathy.
Above all the print and electronic media need to use their reach in educating people about the necessity of allowing organ donation in the unfortunate situation involving imminent death of their near and dear ones.