Any medical people here? (questions about death)

[Coyote_Bandit]

Not asking for medical advice. Just need some help understanding a situation that does not involve me, a family member, or anyone I have the ability to make medical decisions for. It does involve someone I know and a terrible tragedy I am watching unfold. I'm asking for information so I can anticipate how medical events might develop - and how I can support the survivors.

My understanding is that death is determined by 2 independent physician exams usually made within a 24 hour period that find no evidence of brain activity. Usually that means 2 flatline EEGs. No determination of death can be made even if there is only minimal brain stem activity identified. Is that correct?

Will someone with only minimal brain stem activity continue to deteriorate until death can be determined? Or are they more likely to enter a persistent or permanent vegetative state?

My understanding is that the removal of life support may hasten death in this situation - but will also cause organs and tissue to deteriorate and no longer be viable for transplantation and harvesting. The victim may or may not continue to have cardiac and respiratory function after life support is removed. If they do, those functions may or may not deteriorate. If death results from the deterioration of cardiac and respiratory function after the removal of life support then organs and tissue may no longer be viable for transplantation. Is that correct?

Thanks for any insight.

[kestrel91316]

1. What state is this in? State laws vary considerably. Also, does anybody

hold medical power of attorney. My sister does, for my mom in WI, who is in assisted living. She gets antipsychotics and pain meds as needed, but no other meds, and is a DNR (she is bedridden with SEVERE dementia). My sister decides the level of medical care (with my blessings) and nobody gets to interfere.

[Coyote_Bandit]

3. The spouse

will be making all the medical decisions. To my knowledge there is no DNR, health care directive or medical power of attorney. The victim was young, active and healthy before suffering a ruptured brain aneurysm

[kestrel91316]

2. I didn't answer a single part of your question. Sorry.

[Warpy]

4. Minimal brainstem activity is not all alike

and will result in the preservation of autonomic functions like breathing and heart rate in some people, fail in others. There is little way to know without removing life support.

The person is most likely to enter a persistent vegetative state if that's the case, although some people who are capable of breathing off the vent might exhibit some signs of minimal consciousness later. Think Schiavo, with her eyes open and non purposeful body movements.

As for the degradation of organ systems, they'll know quite quickly whether or not the brainstem activity is sufficient for respiration.

As a practical matter, few people that gravely injured survive long, even with spontaneous respiration.

The family and friends will need all the support you can give, no matter what the outcome is.

As for transplantation, the heart is the most vulnerable to degradation and might not be usable. Other organs and tissues will be.

[Coyote_Bandit]

10. There is no

pain response or reflex response. I'm told that the victim did have respiration and cardiac functions when briefly taken off life support. I am fearful that the victim will enter a persistent or permanent vegetative state. I believe the family wishes to donate organs if possible.

At this point it seems to me that nothing can really be done - other than remove life support and just see what develops.

I'm praying that death comes quickly. The victim is gone and has had no higher brain function for days now. The survivors need some closure so they can find the new "normal" in a life that no longer includes the presence of a spouse and parent.

[Warpy]

12. I read your other responses

and the progressive nature of the damage might render a future EEG completely flat. In that case, the organs can be harvested if the family consents and all will likely be viable.

[Barack_America]

5. It can also be determined clinically by a neurologist....

...by examining such things as response to pain and various reflexes.

The problem with just using diagnostic tools alone, is that sometimes there can still be blood flow to the brain and electrical activity that doesn't correlate well with function.

This link may help:
http://jama.ama-assn.org/cgi/content/full/301/11/1192

I'm sorry that you're facing this situation, in whatever manner.

[Coyote_Bandit]

7. I'm told that

there is no pain response or reflex response. I'm also told that the victim did have respiration and cardiac functions when briefly taken off life support.

Thanks for the link and the well wishes.

[mike_c]

6. I don't think it's possible to answer without some more info about the situation....

Was the loss of higher function due to injury? Was the patient relatively healthy previously? Or was the loss of higher function caused by aging, or disease? If the later, what condition?

All of these circumstances can affect whether the patient continues to decline or has a chance of stabilizing without higher brain function. And of course, anyone can beat the odds for a while, so there aren't any certainties.

[Coyote_Bandit]

8. The victim

was young, active and healthy before suffering a ruptured brain aneurysm. The aneurysm was surgically repaired but the victim suffered a progressive stroke following that operation.

Yes, I know there are no certainties. Just trying to define the various scenarios that may play out here.

[SoCalDem]

9. When my best friend's son died, they kept the life support going for 9 days

and showed her his EEG every day , ..and gently talked to her about organ donation. On the 9th day she agreed. I don't remember the exact sequence, but he was a multiple organ donor ..24 years old 6 days away from turning 25.

[Coyote_Bandit]

11. I'm sorry for the loss of that young man

The survivors here recognize that the victim is gone and there is no hpe for recovery. But yet some brain stem function remains. There was respiration and cardiac function when life support was briefly removed. With the uncertainities they don't know what to expect.

[uppityperson]

13. My condelences

I started to answer from a legal viewpoint but am rereading and seeing you have questions about how quickly someone dies, how this affects the ability to use organs later.

Typically the ability to breath goes first. So long as a person has even low blood pressure, so long as their heart is beating, their body can remain alive on a respirator for quite some time and the organs remain useful for transplantation.

Taking someone off a respirator may kill them if they cannot breath on their own, or if they have enough left in them to breath, may not. Someone with minimal brain stem activity may hang in there or may deteriorate, it all depends. I wish I could give you a plain and simple answer, but it depends on what neurons are still connecting. You are right with the "may or may not" and not knowing is really difficult.

Have you a local organ donor place to call, or perhaps do an online search on "organ donation" for more specifics?

Again, my condolences.