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Organs are allocated in a fair manner so as to not discriminate
against anyone due to race, wealth or celebrity status. There
is an occasional situation when donor families know another family
member or friend that is awaiting organ transplantation. The
family can elect to "direct the donation" to that individual.
This "directed donation" is carried out if the organ
is of compatible size and blood type and is also accepted by
the transplant center where the patient is listed.
Deceased Donor
To qualify as
a deceased donor, you must meet brain death criteria
What is brain
death?
Brain death occurs when a person has an irreversible, catastrophic
brain injury, which causes total cessation of all brain function
(the upper brain structure and brain stem). Brain death is not a
coma or persistent vegetative state. A physician not associated with
the transplantation team determines brain death.
Brain death occurs when blood and the oxygen
it carries cannot flow to the brain. Without blood and oxygen, the
brain dies. When the brain dies, the person cannot move, breathe,
think or feel. Pain and suffering ceases. The heart can continue
to beat for awhile as the ventilator (breathing machine) provides
artificial support and oxygen to the body. It may look like the person
is sleeping because the ventilator fills the lungs with oxygen and
helps keep the skin pink and warm. They are not sleeping. Brain death
is death and cannot be reversed.
There are two ways of defining death. One is
brain death, meaning the brain has stopped working and will never
recover. This is different from coma, which is when someone is unconscious
because of brain injury, but the brain still works and may heal eventually.
The other definition of death is when the heart has stopped forever.
This is called cardiopulmonary death.
How can brain death be determined?
Clinical Exam - First, the absence of function
of all parts of the brain, as determined by clinical assessment (no
movement, no response to stimulation, no breathing, no brain reflexes.)
Confirmatory Tests - Next, there is no electrical
activity in the brain; this is determined by an EEG. Finally, there
is no blood flow to the brain; this is determined by cerebral blood
flow studies.
There are several ways in which a person can
become brain dead, these include:
Anoxia - caused by drowning, respiratory diseases
or drug overdose.
Ischemia - blockage of an artery leading to the
brain or in the brain, heart attack (stoppage of the heart for a
period of time), bleeding in the brain.
Intracranial hemmorrhage - caused by a head injury
(a blow to the head) or a ruptured aneurysm. The ballooning of a
blood vessel supplying the brain - can cut off blood supply or rupture.
A gunshot wound to the head - causes destruction
of brain tissue and swelling of the brain.
Brain tumors - can destroy brain tissue and increase
pressure within the brain, but do not go outside the central nervous
system so organs are not affected.
When any of the above occur, they cause swelling
of the brain. Because the brain is enclosed in the skull, it does
not have room to swell, thus pressure within the skull increases
(this is "intracranial pressure"). This can stop blood
flow to the brain; killing brain cells and causing herniation of
the brain (pushing the brain outside of its normal space). When brain
cells die, they do not grow back, thus any damage caused is permanent
and irreversible.
Some points to note:
* A person’s heart can still be beating because of the ventilator
and medications helping to keep the blood pressure normal.
* A person who is declared brain dead by brain death criteria is legally
dead.
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