A Difficult Concept
In a healthy body, the organs and the brain are supplied with oxygen-rich blood. The brain is in charge of the body and must have a good supply of this oxygen-rich blood in order to do its job.
There are two ways that people die. One is called cardiopulmonary or cardiac death, when breathing and heart beating stop. The other is brain death.
If the brain is damaged due to a severe head injury, stroke or tumor, or if the blood supply to the brain is stopped, it can no longer oversee the body's functions. The brain has multiple cells, each one with a specific function. Once a brain cell dies, it cannot be repaired or replaced.
If there is enough damage to the brain because of a lack of blood supply, the brain dies. It can never work again. Brain death is death. It is not reversible. If all tests show the brain is no longer functioning, the patient has died.
A physician who is not part of the transplant team performs specific examinations and follows specific guidelines to determine whether brain death has occurred. This testing process may take several hours. After the absence of brain activity is determined, the diagnosis of brain death is confirmed. Once someone has been declared brain dead, there is no chance for that individual to recover.
The patient no longer has any sensations and cannot feel pain. He or she may have normal color and warm skin because the ventilator keeps oxygen and blood flowing in the body. The chest continues to move up and down with artificial breaths from the ventilator. Because death has occurred, breathing is not possible without the ventilator. The ventilator can only supply the heart and lungs with oxygen for a limited amount of time. To see a comparison of criteria for an organ donor and tissue donor go to the Determination of Donation chart.
Time of Death
The legal time of death occurs when the physician declares the patient brain dead. Discontinuation of the ventilator does not cause death.
Organ Donation
Organ donation may be an option for the patient's family because the person is on a ventilator, which keeps the heart beating and oxygen-rich blood flowing to all of the vital organs. As long as the ventilator is maintained adequately, organ function can usually be sustained.
During that time, the patient remains in the critical care unit until taken to the operating room for removal of donated organs. After the transplant surgeons complete the surgical recovery of the organs, the ventilator is removed. A procurement transplant coordinator remains with the patient throughout the procedure.
Donation and transplantation offer a second chance at life for people who have end-stage organ failure. Many donor families report donation has enabled them to feel something positive from a tragic event.