Communicating Brain Death to Families - Copy

Communicating the Critical Elements of

Brain Death to Families

1. Team Huddle.

Discussion of the plan for Brain Death testing includes MTN staff, bedside nurse and attending
h ii

2. Brain Death Assessment.

Family offered the opportunity to watch the assessment per
physician discretion if appropriate.

3. Pronouncement of Brain Death

Family is escorted to a private room with hospital and MTN team. Everyone is introduced. The
patient’s clinical course from admission is shared, in understandable terms, including

mechanism of injury, interventions and diagnostic tests completed on the brain (with visual aids
if appropriate). Physician shares results of brain death assessment with family. Ex: “Sadly, this
means that your loved one has died. His (her) death certificate will show that he (she) died at

____ today.” Open the room for family questions, verify understanding.

Provide condolences to family.

4. Allow Silence and Be Present

The care of the patient does not change unless a plan is made with the family. Allow time
for the family to process this information. Be present to provide support. The family may
react in a number of emotional ways. Based on possible family responses below we have

provided some common transitional language to discuss donation options.

Silence Very Emotional or Anger Ready for Next Steps

“Please take some time “You have just heard a lot “(MTN coordinator
with your loved one. of information. Please name), a member of the
When you are ready a care team, is here to help
take some time with your you discuss next steps. I’ll
member of the care team loved one. We are here step out of the room but
will be ready to talk with when you are ready.”
you about next steps.” Listen and address any remain available for
questions.”
concerns.

Note: Only MTN (or a trained designated requestor) should offer donation to a family.
Families receive the prognosis better in the above order. Deviations from the above decrease

acceptance in the pronouncement, trust within the team and authorizations for donation.

Explaining Brain

n Death Testing

What has  Your lo
happened?
their b

 The co

appea

 Please

done.

 Brain d

oved one has sustained a devastating injury to
brain including the brain stem.
omponents of their brain that sustains life
ars to no longer be functioning .
e know all treatments to prevent this have been

death is not the same as a coma.

The Brain and Vision and
its functions. perception

Memory

Language Intelligence,
and judgement
hearing and
behavior

Balance and
muscle control

Breathing,
consciousness and
involuntary
responses

What happens  The Ph
now?
Exam.

 The Ph

loved

 The br

one.

 The br

brain t
life.

 Brain s

 Pu

hysicians are going to perform a Brain Death
.
hysicians are looking for any signs of life in your
one’s brain.
rain death exam will not be hurtful to your loved

rain death exam will be testing the part of the
that control involuntary reflexes which maintain

stem signs of life include the following reflexes:

upils, corneals (blinking), cough, gag, breathing

Brain stem  Pupils
functions to be
 Pu
examined.
in
br

 Corne

 Co

wi
sta

 Calori

 Co

m

s

upillary response is involuntary. A bright light will be
ntroduced to the eyes. Pupils will change shape if the
rain stem is functioning.

eals

orneal or blink response is involuntary. A soft material
ill be introduced to lightly touch the eyes. Blinking will
art if the brain stem is functioning.

ic Test

old water will be introduced into the ears. The eyes will
move if their brain stem is functioning.

Brain stem  Cough
functions to be
 Th
examined.
tu
br

 Th

to
A

h and Gag

he suction catheter will be moved down the breathing
ube to examine a cough reflex. A cough is present if the
rain stem is functioning.

he breathing tube will be slightly manipulated or a
ongue depressor will be introduced to illicit a gag reflex.

gag is present if the brain stem is functioning.

Brain stem  Pain
functions to be
 Pa
examined.
re
sti

 Please

with o
reflex”
stem.

ainful stimulus will be applied to illicit any type of
esponse. If that part of the body moves away from the
imulus, the brain stem is functioning.

e note sometimes the body spontaneously moves
or without stimulation. The can signify a “spinal
” which is not related to the functioning brain

Breathing  An initia
Exam
dioxide
be starte

 100% ox

 The vent

disconne
be provi
remains

 The med

and fall
stopped

 A second

machine
breathin

al blood test will be completed to look at the carbon
and oxygen levels. In order for the breathing exam to
ed, these levels need to be within normal range.

xygen will be provided for approximately 10 minutes.

tilator machine will be turned off and temporarily
ected from the breathing tube. Oxygen will continue to
ided through the breathing tube. The breathing tube
s in place.

dical team observes the chest and looks for it to rise
for 10 minutes. If there is any instability, the test will be
d.

d blood test will be repeated and the ventilator
e will be turned on and reconnected to the patient’s
ng tube.

Results of  If any
breathing
brain s
exam.

respiratory effort or breathing is present, the
stem is functioning.

Other possible  In the
brain stem
exams. perfor
Radiol

event some of the other exams cannot be
rmed, the patient may be transferred to the
logy Department for special x-rays.

What does this  The pa
all mean?
Unfort
brain d

 Brain d

 The m

atient did not respond to any of the exams.
tunately, the brain is not functioning which means
death has been determined.

death is not reversible.

machines are supporting the functions of the body.

What is next?  You wi

 The ca

 If any

may b

ill be given some time with your loved one.

are of your loved one does not change.

additional care decisions need to be made, you
be introduced to additional care team members.

F A Qrequently sked uestions

families may pose about brain death during their loved one’s ICU stay,
and suggested responses to maximize understanding of the complex diagnosis

*not* for family distribution

“What does brain death mean?”

There are two types of human death. The much more common, and most familiar, is when the heart
stops beating and cannot be restarted. Brain death, which is very rare, is the complete and irreversible
cessation, or ‘stopping’, of all brain function. The heart continues to beat. This occurs when the brain
lacked blood flow and oxygen because of an injury. Once that occurs, the brain dies and cannot be
revived.

“What causes brain death?”

Lack of oxygen to the brain, and/or swelling of the brain, which can be caused by multiple types of
injuries. Head trauma from any motor vehicle crash, falls, gunshot wounds, head bleeds from
aneurysms and strokes, drowning/poison victims are some examples. Any circumstance that causes a
lack of oxygen to the brain, such as patients who suffer cardiac arrest, receive CPR, and their heart was
able to be restarted. Sometimes in those situations the blood flow to the brain is inadequate or absent,
and the brain dies.

“How is it decided that my loved one is brain dead?”

A physician conducts the required medical tests to diagnose Brain Death. These tests are based on
acceptable medical practices that comply with state laws on death.

“Why don’t we just withdraw care and just shut everything off instead of doing the
brain death exams?”

Choosing ‘comfort care’ would not be appropriate in this situation because that is a decision made on
patients who are still alive. In addition, the decision to ‘shut everything off’ is typically an emotional
decision that can cause added worry and grief to you. In your loved one’s situation, we think he/she
has already died. The Brain Death tests will confirm that.

“Is my loved one in pain?”

No. When someone is brain dead, there is no feeling of pain because all sensations are generated from
the brain. Your loved one’s brain is not showing any signs of life.

“How can he/she be dead, yet the heart still be beating?”

Brain death is the complete and irreversible loss of all brain function, regardless if the heart is beating
or not. In your loved one’s situation, the ventilator is providing oxygen currently to keep the heart
beating. As long as the heart has oxygen, it can continue to work.

“What happens to our loved one while these tests are being done?”

Your loved one is on a machine that breathes for him or her, called a ventilator, because the brain no
longer sends signals telling the body to breathe. Your loved one is also being given medications to
maintain blood pressure and other body functions temporarily. These treatments continue during the
brain death tests and continue after the tests are complete.

“Are there medications or conditions that can give a false positive?”

Certain drugs can mask brain functions. Your loved one’s body is clear of these substances/will be clear
of any of these substances before the brain death tests are performed. Then the physician can
accurately assess for any signs of life in your loved one’s brain. Other confirmatory tests can be
performed in certain circumstances which are determined by your physician.

“Is brain death like being in a coma?”

No. Brain Death is not a coma. A patient in a coma continues to have some level of brain activity, such
as breathing without a machine, or being able to cough. When Brain Death occurs, all brain functions
stop and don’t come back.

“Is there anything else that can be done?”

Before brain death is declared, everything possible is done to save your loved one’s life. After the brain
death tests are completed, there is no chance for recovery. There is no medical miracle that will
reverse Brain Death.

“What happens after my loved one is declared brain dead?”

Your family will be provided the time of death that will appear on the death certificate. The time of
death is not the time the ventilator is removed.

“When do all the machines get turned off?”

Saying goodbye to a loved one who is brain dead is a very difficult experience. Your loved one could
look like they are just sleeping. Other families in similar situations have used this time to spend those
last moments with your loved one before turning off the machines. Some members of the care team
will be coming to see you soon about next steps and saying final goodbyes.