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?
Full Answer Section
Procedure upon Brain Death Determination:
Once brain death is declared, the following steps are typically followed:
- Family notification: The family is informed about the diagnosis and given time to grieve.
- Organ donation discussion: If the patient is a registered organ donor or expressed a wish to donate organs, the family will be approached about consent for organ donation.
- Medical management: The patient's vital functions are maintained artificially until organ donation procedures can be completed.
- Organ procurement: Organs are carefully retrieved and transported to transplant centers to save lives.
Who Approaches the Family about Organ Donation:
The family should ideally be approached by a trained coordinator who specializes in organ donation discussions. This person should have expertise in communicating with families in sensitive situations, explaining the process of organ donation, and addressing their concerns and questions.
Respecting the Patient's Wishes and Family's Decision:
In this case, the patient clearly expressed her wish to be an organ donor on her driver's license. However, her mother refuses to consent. This presents a complex ethical dilemma.
Arguments for Donation:
- Respecting patient autonomy: Donating organs would honor the patient's expressed wishes and fulfill her intention to help others after her death.
- Saving lives: Donated organs can save the lives of many individuals waiting for transplants, offering them a second chance at life.
- Meeting societal need: There is a significant shortage of organs available for transplantation, and honoring donations can contribute to saving more lives.
Arguments against Donation:
- Family autonomy: The final decision ultimately rests with the family, and the mother's refusal should be respected, even if it contradicts the patient's wishes.
- Respecting cultural or religious beliefs: Some families may have religious or cultural beliefs that oppose organ donation, and their wishes should be considered with sensitivity.
- Grief and emotional strain: The family may be experiencing intense grief and may not be emotionally ready to make such a significant decision.
Ethical Consequences:
There are ethical consequences associated with both decisions:
Donating organs:
- Ignoring family wishes: Overriding the mother's refusal could be perceived as disrespectful and may cause further emotional distress.
- Potential legal challenges: If the family objects strongly, there might be legal challenges to proceeding with organ donation.
Not donating organs:
- Disregarding patient autonomy: Failing to honor the patient's expressed wishes could be seen as unethical and disrespectful.
- Missed opportunity to save lives: Denying organ donation could deprive several individuals of a chance to survive and live longer lives.
Conclusion:
There is no easy answer to this complex ethical dilemma. Ultimately, the decision needs to be made on a case-by-case basis, considering all relevant factors, including the patient's wishes, family's beliefs, and applicable medical and legal considerations. Open communication, sensitivity towards the family's grief, and adherence to ethical principles should guide the decision-making process.
Sample Answer
Testing for Brain Death:
To diagnose brain death in a patient with a cerebral aneurysm, several tests might be performed, including:
- Brain stem reflexes: This involves testing the patient's response to various stimuli, such as corneal reflex, pupillary reflex, and gag reflex.
- Apnea test: This test assesses the patient's ability to breathe spontaneously. It involves stopping mechanical ventilation for a specific period and monitoring for any respiratory effort.
- Electroencephalogram (EEG): This test measures electrical activity in the brain. Flatline activity for a specific duration indicates brain death.
- Angiography: This imaging test may be used to confirm the presence and location of the cerebral aneurysm, which can support the diagnosis of brain death.
These tests need to be performed twice, 24 hours apart, by different physicians, to confirm brain death definitively.