My first encounter with brain death was back in the early 1970s. I was a new RN in a shock-trauma unit. We admitted a 17-year-old young woman who had attempted suicide by jumping out of a fifth-floor window. If it wasn’t awful enough, I remember it was Thanksgiving weekend and she had been home from college.

Angiograms of normal blood flow in an active brain (at left) and lack of blood flow indicating
brain death. Photos © Fusionspark Media Inc.

As one might imagine, she sustained massive injuries, including severe head trauma. She had been intubated at the scene and was on a mechanical ventilator. Her pupils were fixed and dilated, and she had no spontaneous respirations and virtually no brain activity, according to electroencephalography (EEG) studies.

A gradual refinement of criteria.

I recall that there had to be three consecutive EEGs done before we could remove the ventilator. There was no ethics committee or formal meetings with hospital attorneys or administrators—just the physician, the family, and the pastor. And then the patient’s siblings and grandparents came to say goodbye. It was heart-wrenching.

Things have gotten more defined and complex since then, as our March article, “Brain Death: History, Updates, and Implications for Nurses,” details. Since the first attempt in 1968 to set a definition and guidelines for brain death, there have been refinements in the criteria that most states but not all subscribe to; disagreements by experts; legal, ethical, and religious challenges; and several high profile cases where family wishes and hopes collided with medical realities.

Vital to have a clear understanding.

As the authors note:

During brain death testing and for a certain period following a brain death declaration, the brain-dead patient continues to receive intensive nursing and medical care, similar to the care provided prior to the brain death declaration. The brain-dead patient’s body is thus warm to the touch, the chest moves with ventilatory support, vital signs are present, and in some cases the extremities move reflexively. Nurses and other clinicians should be prepared to manage family grief reactions, including the rejection of the diagnosis.

It’s vital that nurses have a clear understanding of the criteria and policies their states and hospitals follow so that they can answer questions from families and be supportive. At the same time, nurses need to wrestle with their own ethical and religious beliefs about when death occurs. This article provides a good foundation for beginning that exploration.

The article is free to read and available for CE credit.