SUPPORTING THE BRAIN DEATH DECLARATION THE ROLE OF PALLIATIVE CARE

May Ronci, RN, CHPN Lori Carlton-Mowry, MSW, ACSW

Frequently What is brain death? Asked Questions Brain death occurs when a person has an irreversible, catastrophic brain injury, which causes total cessation of all What Tests can be used to brain function (the upper brain structure and brain stem). evaluate brain death? Brain death is not a coma or persistent vegetative state. Brain death is determined in the hospital by two physicians. • Apnea Test: The apnea test looks for a patient’s effort to breathe on their own. If • Some causes of brain death include, but are not limited to: someone cannot breath on • Trauma to the brain (i.e. severe head injury caused by a motor vehicle crash, gunshot wound, fall or blow to the head) their own, this is considered a very strong • Cerebrovascular injury (i.e. stroke or aneurysm) confirmatory test for brain • Anoxia (i.e. drowning or heart attack when the patient is revived, but not before a lack of blood flow/oxygen to the brain death. has caused brain death) • Brain tumor • Electroencephalogram (EEG): An EEG measures If my loved one is brain dead, what does that mean? electrical activity in the When someone is brain dead, it means that the brain is no brain. An EEG can help longer working in any capacity and never will again. When caregivers evaluate the brain death is declared, it means your loved one has died. presence of electrical activity of the brain and the Your loved may not appear dead because the chest will type of electrical activity continue to rise and fall with the ventilator providing breaths, that is occurring. This can and the body may feel warm to touch. Occasionally, a be used to help diagnose person’s limbs or torso (the upper part of the body) may move, even after brain death has been diagnosed. These brain conditions such as spinal reflex movements are generated by the spinal cord seizures and brain death. and don't involve the brain at all. Therefore, they won't affect the diagnosis of brain death.

We use the words death and died to acknowledge the death Worden’s Tasks What was he like before he died? What did he like to do? What of Grieving were his quality of life values? – Reinforces life versus death We encourage them to name and express the loss

You are in a safe place. You’ve had a great loss. Let it out. What (1) To Accept the Reality of are you feeling? - Invites the mourner to verbalize the loss the Loss and begin to feel it

We help identify how they might carry on without the (2) To Work Through the deceased and who will help them move forward Pain of Grief What resources and supports will you need to go on? How can

we help you to get there? What strengths have you used to (3) To Envision/Adjust to an cope before? What is already in place to help you? Environment Without – Reinforces the ability to survive the loss and move forward the Deceased to a new normal How will you memorialize/honor him? What will you carry (4) To Find an Enduring with you? Connection with the What will you keep from the relationship? What will you share Deceased While Making as a family? How will you feel his influence now as begin a a New Life journey apart? - Reinforces changed relationship, implies ability for new acceptable relationship (in time), legacy (Worden, 2008, Grief Counseling and Grief Therapy)