Your patient is a 23-year-old female with a history of headaches.

Your patient is a 23-year-old female with a history of headaches. This morning she was experiencing a really bad headache as her boyfriend was driving her to the university. He thought she was sleeping and by the time they got to the school, 45 minutes later, she was not waking up. She was diagnosed with a cerebral aneurysm and you are taking care of her in the Neurological ICU.
What testing do you expect to be performed to diagnose brain death?
What is the procedure when a patient is determined to be brain dead?
Who should approach the family about organ donation?
The family is approached about organ donation. The patient indicated on her driver’s license that she wanted to be an organ donor. Her mother refuses to consent for organ donation.
Do you think donation should happen anyway? Why or why not?
What will be the ethical consequences of your decision?

ANSWER

Testing to Diagnose Brain Death

To diagnose brain death, a series of tests will be performed to confirm the irreversible loss of all brain function. These tests may include:

Clinical examination: A thorough neurological examination will be conducted to assess the patient’s level of consciousness, brainstem reflexes, and pupillary responses.

Brainstem apnea test: This test assesses the patient’s ability to breathe spontaneously. If the patient does not breathe when carbon dioxide levels rise in their blood, it indicates a loss of brainstem function.

Ancillary tests: Additional tests may be performed to confirm brain death, such as electroencephalography (EEG), which measures brain activity, or cerebral angiography, which visualizes blood flow in the brain.

Procedure for Determining Brain Death

The diagnosis of brain death is made by a team of experienced medical professionals, typically neurologists and intensivists. The team will carefully review the patient’s clinical history, physical examination findings, and results of the diagnostic tests. A consensus diagnosis of brain death is reached when all neurological functions are determined to be irreversibly lost.

Who Should Approach the Family About Organ Donation

The decision to approach the family about organ donation typically falls upon the hospital’s organ procurement organization (OPO) team. The OPO team is responsible for identifying potential organ donors, educating families about organ donation, and coordinating the process of organ recovery and transplantation.

Family Refusal of Organ Donation

In the case of the 23-year-old patient, her mother’s refusal to consent for organ donation poses a challenging ethical dilemma. While the patient’s driver’s license indicates her wish to be an organ donor, the decision to donate ultimately rests with her next of kin, in this case, her mother.

Ethical Considerations

The ethical considerations surrounding this situation involve respecting the patient’s wishes, honoring the family’s decision, and recognizing the potential benefit of organ donation to save lives.

Respecting Patient Wishes: The patient’s clear indication on her driver’s license to be an organ donor suggests her desire to contribute to saving others’ lives. However, her wishes cannot be imposed upon her family, and their decision must be respected.

Honoring Family Decision: The patient’s mother’s decision to refuse organ donation reflects her own beliefs and concerns about the situation. Her autonomy as the patient’s next of kin must be acknowledged and respected.

Potential Benefit of Organ Donation: Organ donation has the potential to save and improve the lives of individuals awaiting transplants. Denying this opportunity can have significant consequences for those in need.

Conclusion

The decision to proceed with organ donation in this case is complex and involves balancing the patient’s wishes, the family’s decision, and the potential benefit to others. Ultimately, the decision rests with the patient’s mother, and her choice must be respected.