Brain death and perioperative management of the brain-dead organ donor

Brain death is the irreversible cessation of all functions of the entire brain, including the brain stem. rain death occurs when the lower brain herniates through the skull onto the brainstem and pons, cutting off the blood supply to the brain. Diffuse cerebral edema and hemorrhage contribute to this herniation. There is no medical intervention to reverse this process, and brain death quickly follows. Upon verification of herniation by cerebral flow studies, brain death criteria tests are initiated by the physicians and are regulated by state and federal guidelines. Families facing brain death verification and organ donation need a great deal of emotional support. After herniation, ICP values return to baseline normal. Many of the patient’s vital signs also return to normal. Vasopressor therapy may be reduced or halted, and sedation drugs are ceased so as not to interfere with brain death testing. After determination of brain death, if organ transplantation is being pursued, the patient undergoes a series of tissue and blood typing tests, and the medical focus shifts to optimal organ perfusion and oxygenation. Families offering a loved-one’s organs for donation need emotional support during this phase because even though their loved one is dead, machines and medications continue to keep the lungs breathing and the heart beating. These families are not afforded the kind of closure that comes from holding their loved one and saying goodbye after the heart stops. Organ donation is .