Brain Death

Susan Asks:

My character ends up killing himself in order to be a heart donor. Problem is how does he kill himself without damaging the heart? Also, there needs to be enough time for EMT’s to reach him before his heart stops. Therefore he needs to be brain dead only . . . Is it something he could plan or is it too far fetched? For instance, a shot to the head?

Jordyn Says:

Hi, Susan.

Very interesting if not morbid question you ask here. It sounds like what this character is trying to accomplish is some sort of directed organ donation upon his death. His demise would have to ensure brain death, but also ensure that paramedics arrive in time to at least establish a heartbeat and get him to the hospital. There is a narrow window for this to happen. The most common time frame given for brain death is lack of oxygen for four to six minutes after the heart stops beating.

This character would have to time his heartbeat stopping and then EMS arriving around four to six minutes after. I actually would probably not choose a gunshot wound to the head. There could be a couple of things problematic with this. EMS might not choose to treat if the wound looked particularly devastating. Also, if there were damage to the facial structures, particularly the airway itself, resuscitation to even get a heartbeat back would be challenging.

I think an injury caused from anoxia (or lack of oxygen) would be your best choice. Of those, I would think drowning, hanging, ingestion of sleeping pills and/or drugs (that wouldn’t cause heart damage), and possibly carbon monoxide exposure might be your best options in my opinion. However, there is discussion in the literature whether or not it is wise to donate the organs from someone who died as a result of carbon monoxide poisoning.

Hope this helped and good luck with this story!

The brain is our most complex organ and perhaps the most difficult to help heal. The biggest challenge is its protective covering: the skull. Management of acute traumatic brain injury, or TBI, typically involves manipulating the three components within the skull: the brain, the blood, and the cerebrospinal fluid (CSF).

What is the purpose of each of these components? The brain is the body’s supercomputer. The blood delivers oxygen and nutrients to feed the cells or neurons. The CSF nourishes the brain, helps remove waste products, and keeps the brain buoyant.

What happens when something is significantly injured? It swells. Think about a time you saw someone with a really bad sprained ankle. What happened? It blew up like a balloon. The same thing happens to the brain with a traumatic injury. It swells.

Unlike an ankle, brain swelling is inhibited by the skull but the pressure inside the head can continue to rise if swelling is unchecked. Too much pressure inside the skull (it can’t move) and blood flow diminishes, thereby starving cells of oxygen, which then swell more.

We can measure the pressure inside your skull, or intracranial pressure (ICP), by placing a sensor into a ventricle (a ventriculostomy). A normal ICP is 7-15mmHg. Cerebral edema can be insidious as swelling peaks 48-72 hours post injury. A patient can initially present following commands. Then in 2-3 days, develop cerebral edema to the point of herniation (which means brain contents shifting) and die.

What happens when a patient develops significant cerebral edema and ICP pressures skyrocket?

First bad thing: Blood flow is reduced. The brain is very sensitive to blood flow and greedy for oxygen. If there is diminished blood flow, neurons (brain cells) begin to die. If there is no blood flow, the brain will die. You may have heard the term brain death. This is determined by several factors but the definitive one is by taking the patient to radiology and doing a brain flow study. Roughly, a dye is injected into the blood and x-rays are taken. If there is no blood flow, the patient is declared brain dead.

Second bad thing: Brain contents shift into areas where they’re not supposed to be. This is called herniation. When neurons are compressed, they don’t function properly and will begin to die as well. When brain cells die, machines and medications have to take over their function to keep the patient alive.

Unfortunately, if brain death has occurred, the medical team will start discussing withdrawal of care with the family.

***Content reposted from January, 12, 2011.***