Ethical Dilemma: Brain Death
University of Phoenix
There has been an increase in the number of organs donated for transplantation since the development and acceptance of brain death. (Guidelines for the determination of death, 1981) The strict rules surrounding the diagnosis and the ability to develop individualized Policy and Procedures in the determination of brain death has removed the fear of law suite surrounding this definition of death. (Guidelines for the determination of death, 1981) Old vs. New
Until brain death was introduced the diagnosis of death was the lack of cardiac function. Without a heart beat blood did not circulate and oxygen could not be delivered to the body in order to sustain life. Research showed that with out brain function the body organs over a period of time shut down as they are not getting the signals from the non-functioning brain. Once total and complete function of the brain is lost there is no way to restart or regenerate the function of the brain. For this reason the term of brain death was developed and accepted by the medical community as a legal state of death. (Determination of death, 1980) The hard part for the medical and general public to accept was the person pronounced dead by brain death criteria was warm, breathing assisted by a ventilator, had a heart beat, and for all appearances was still alive just sleeping or in a deep coma. People felt if given time the person would just wake up. Still today years since the term and definition was introduced families are still having a hard time accepting the definition and that their loved one is legally dead. Ethical Dilemma
While organ donation has increased with the development of brain death criteria the diligence need in order to protect the patient has as so grown. Following the organizations Policy and Procedures step by step in order to make the determination of brain death is paramount. When a transplant coordinator is called to the hospital to evaluate the patient for organ donation one of the first duties is to determine that the patient meets both organ bank standards and organizational Policy and Procedures for the diagnosis of brain death. As the transplant coordinator assigned to AMH for the recovery of solid organs for transplant it was determined that this was not the case. Dr. RD had pronounced the patient brain dead. Approached the family about organ donation and received the proper consent from the family. Dr. RD stated in the chart that the Policy and Procedure was followed and that the patient was pronounced dead. This organizational Policy and Procedure was that one other doctor not involved in the case was to review the findings and agree with them. This was all so done in a progress not by Dr. LB. The organ procurement agency has a Policy and Procedure that all transplant coordinators must follow. All transplant coordinators do not have any personal relationships or involvement in the care of any patient until after the documentation of death has been made in the chart. One of the steps in the organ procurement agencies Policy and Procedure for confirmation of the brain death diagnosis is to turn the sensitivity of the ventilator off. This means that if the patient triggers the ventilator by attempting to breathe the determination of brain death is false. This patient did just that. Not only did the patient trigger the ventilator the patient maintain a minute rate that could sustain life. While there may be upper brain death the brain stem may still function. That was the case here. The ethical dilemma here was to continue with the recovery process or report the findings. This patient had suffered a sever brain injury and would not recover from it. The patient was not going to recover nor wake up from this injury. Only the brain stem had...