Question

John T. was involved in a high-speed motor vehicle accident and sustained intracranial hemorrhage from hitting his head on the windshield. After a week of aggressive brain resuscitation therapy, including an induced barbiturate coma, John was declared brain dead. His family declined organ donation. Ventilator withdrawal is being postponed until John’s sister arrives from out of town. She is expected tomorrow. Discussion Questions: 1. What are the possible reasons John’s family opposed organ donation? 2. What does it mean he is Brain Dead? What are the clinical signs? 3. What are the implications of postponing ventilator withdrawal while waiting for the sister? 4. What processes are necessary during ventilator withdrawal to insure John’s comfort and peaceful death? 5 . How could you (as the Critical Care Nurse) assist/prepare the family for the discussion of the necessity of an autopsy since trauma victims are coroner’s cases?

Answer 1

1.Some of the possible reasons for the family to refuse for a organ donation are

• Religious believes and practices
• Fear of loosing the body parts of their loved one
• Inability to accept an incision who is no longer going to survive after surgery
• Emotional and psychological disturbances and unacceptance

2.Brain dead refers to complete cessation of the brain to function which controls certain involuntary actions of heart and lungs.The brain and the brain stem do not function leading to aide of a ventilator to support breathing and stay alive.

An apnea test with reflex test confirms brain death

The signs of brain dead are

• Pupils doesn't react to light
• Absence of response to painful stimuli
• Absence or in a state of irreversible com's
• No reflexes(no corneal reflex,no occulocephalic reflex,no gag reflex,no occult vestibular reflex)
• Patient doesn't breathe by self

3.Some of the implications of postponing ventilator withdrawal are

• The discomfort experiences by the patient which can not be expressed or verbalised
• Increase in level of stress and emotional trauma experienced by the family member
• Increase in the expenditure incurred for the patient
• Aggressive procedure in case of cardiopulmonary arrest
• High risk of putting the patient under infection
• Loss of other organ functions gradually
• Lengthen the dying process

4.The process of withdrawing ventilator which insures that John is in comfort and gets a peaceful death

• Make sure the family members visit the patient
• Clear the respiratory tract for any secretions because post extubation respiratory stridor can occur
• Make sure a respiratory therapist is available
• Work as a team
• Medications and equipment to be kept in place for necessary procedures.

5.Provide a complete description of the care before and after death.

Inform the relatives that autopsy is legal on case of accidents to rule out and confirm the nature of death

Provide psychological support

Get the support of Chaplain  team to console and give a spiritual thinking to the relative.