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Understanding Brain Stem Death

To understand organ donation and the shortage of organs for transplants, one needs to have a basic understanding of brain stem death and what impact it has on whether they can, in fact, be donors or not. Of all the people who die in India each year, a few die under circumstances that make them medically eligible to be organ donors.

Brain stem death is irreversible loss of all brain functions and the person is clinically and legally dead. Brain stem dead persons are those who are in the hospital’s intensive care unit on total artificial life support system. Through this mechanism the heart, lung, liver, kidney and pancreas can be kept alive for a few hours. This is when healthy organs can be surgically removed from a dead person and transplanted in the needy patients.

The general idea of death is that it occurs when the heart stops beating and breathing ceases.

When brain stem death occurs it is different. Though there is irreversible loss of all brain function and the patient is clinically and legally dead, the appearance of life continues. This is only because of a breathing machine (ventilator), which is an artificial means for delivering enough oxygen to the heart to keep it beating. Through this mechanism, the heart, lung, liver, kidney and pancreas can be kept alive for a few hours.

Brain stem death can be confusing, particularly for families who are confronted with the sudden death of their dear ones because a brain stem dead person on a ventilator can look "alive", as their heart is still beating and the ventilator is pumping oxygen and air into the lungs making the person's chest rise and fall.

This makes some families expect that if their loved ones are continuously kept on ventilator they will progress. But the truth is, brain stem dead is to be dead, and no recovery is possible. There is no method to revive a brain that has been deprived of blood and whose cells have died.

How does brain death occur?

Brain death can occur in patients who have sustained injuries to the brain resulting from traumatic causes such as road accidents, falls, blows to the head -- and non-traumatic causes like spontaneous bleeding from high blood pressure or bursting of brain aneurysm, drowning, and carbon monoxide poisoning during which time the brain is deprived of blood and oxygen. A head trauma or bleeding in the brain will cause the brain tissue to swell. The action of the brain swelling inside a closed space and the build-up of pressure is what can ultimately lead to brain stem death. As the brain swells inside the skull, it pushes downward toward the brain stem blocking all upward flow of blood. Depending on the type of injury, this may happen within minutes or over a period of days. Even while the heart is still beating and supplying blood to the rest of the body, blood that carries oxygen cannot reach the brain or the brain stem, which controls heart rate and breathing. The result is that the brain and the person die.

Coma:

Coma is defined as a state of unconsciousness from which the individual cannot be awakened, in which the individual responds minimally or not at all to stimuli, and initiates no voluntary activities. Coma is similar to deep sleep, except that no amount of external stimuli can prompt the brain to become awake and alert. However, the person is alive and recovery is possible.

What is the difference between coma and brain death?

A patient in coma is not dead. Unlike a brain stem dead person, the brain waves and brain stem functions are active and the body is able to maintain vital functions such as regulating the temperature, blood pressure and respiration. Whereas, in the case of brain stem death, the person has no brain waves and no brain stem function; therefore the inability to manage body functions. The organs can be kept alive for a few hours with mechanical assistance.

ORGAN TRANSPLANTATION

What is transplantation?

When an organ from one person is surgically removed and placed into another person it is known as organ transplantation.Insituations where a person’s organ has fully failed due to illness or injury, the only option they have to recover is to undergo organ transplantation.

What are the organs that can be donated?

Solid organs that can be transplanted include heart, lung, liver, kidneys, pancreas and intestine. Tissues that can be transplanted include cornea, bone, cartilage , skin, vein and heart valves.

What does our law state on organ donation?

The Government of India recognizes the concept of brain stem death and has legalized the procurement of organs from brain stem dead persons through ‘The Transplantation of Human Organs Act’ (1994). THOA 1994 and Rules 2008 operational in Tamil Nadu now.