The Dead Donor Rule
Organ donors can be either alive or deceased at the time of donation. Deceased donors will be pronounced dead per cessation of either brain or circulatory activity. The dead donor rule not part of any legislation moreover it is a governing ethical guideline which states that a donor must be pronounced death prior to the removal of life -sustaining organs such as the heart, lungs, liver, and kidneys (Veatch and Ross, 2015). Ethical concerns pertaining death surround the definition of death and the irreversibility of the process of dying. The diagnostic measures that are mandatory for pronouncing a patient brain dead, include tests for the responsivity of the cerebrum and the brain stem. Medical tests that examine the cerebrum …show more content…
The medical tests for testing the responsiveness of the brain stem include pupil response tests, corneal reflex test, oculocephalic test, oculovestibular test, oculopharyngeal reflex test, and the apnea test (Miller and Truog, 2012). A pupil response examination where the physician shines a bright light at the eye and reviews pupil dilation or the absence thereof (Miller and Truog, 2012). A corneal reflex test examines the responsiveness of a patient when a cotton swab touches the cornea; a typical patient will blink, whereas a brain-dead patient will have no response (Miller and Truog, 2012). The oculocephalic test is a procedure where the patients head is turned side to side and typically the patient’s eyes would follow the movement, but in a brain-dead patient they remain stationary (Miller and Truog, 2012). The oculovestibular test seeks to produce eye movement with the introduction of ice water into the ear canals, but no such movement will occur in a patient with brain-death …show more content…
The final test for brain death is the apnea test; the patient is removed from the ventilator to examine the response to increase in carbon dioxide level (Miller and Truog, 2012). If the patient fails all the reflex tests, the patient is diagnosed brain dead at the conclusion of the apnea test (Veatch and Ross, 2015). Typically, apnea test is performed en route from the ICU to the OR where donation will occur (Miller and Truog, 2012). The apnea test is not performed prior to organ donation because the body’s levels of carbon dioxide increase from 40 torr to a dangerous level of 60 torr (Miller and Truog, 2012). If 60 torr carbon dioxide levels are sustained for a long period, there is irreversible damage to the organs and renders them useless for transplantation (Miller and Truog, 2012). One clinical abnormality pertaining to brain death is the occurrence of the “Lazarus sign” (Miller and Truog, 2012). This phenomenon occurs when the neurons in the spinal cord fire rapidly and cause coordinated muscle contraction and can quite literally cause the patient to sit up in bed (Miller and Truog, 2012). It is due to this “Lazarus sign” that family is asked to step out of the room during testing because it can confuse the family into thinking their loved one is alive and not brain dead
Organ donors can be either alive or deceased at the time of donation. Deceased donors will be pronounced dead per cessation of either brain or circulatory activity. The dead donor rule not part of any legislation moreover it is a governing ethical guideline which states that a donor must be pronounced death prior to the removal of life -sustaining organs such as the heart, lungs, liver, and kidneys (Veatch and Ross, 2015). Ethical concerns pertaining death surround the definition of death and the irreversibility of the process of dying. The diagnostic measures that are mandatory for pronouncing a patient brain dead, include tests for the responsivity of the cerebrum and the brain stem. Medical tests that examine the cerebrum …show more content…
The medical tests for testing the responsiveness of the brain stem include pupil response tests, corneal reflex test, oculocephalic test, oculovestibular test, oculopharyngeal reflex test, and the apnea test (Miller and Truog, 2012). A pupil response examination where the physician shines a bright light at the eye and reviews pupil dilation or the absence thereof (Miller and Truog, 2012). A corneal reflex test examines the responsiveness of a patient when a cotton swab touches the cornea; a typical patient will blink, whereas a brain-dead patient will have no response (Miller and Truog, 2012). The oculocephalic test is a procedure where the patients head is turned side to side and typically the patient’s eyes would follow the movement, but in a brain-dead patient they remain stationary (Miller and Truog, 2012). The oculovestibular test seeks to produce eye movement with the introduction of ice water into the ear canals, but no such movement will occur in a patient with brain-death …show more content…
The final test for brain death is the apnea test; the patient is removed from the ventilator to examine the response to increase in carbon dioxide level (Miller and Truog, 2012). If the patient fails all the reflex tests, the patient is diagnosed brain dead at the conclusion of the apnea test (Veatch and Ross, 2015). Typically, apnea test is performed en route from the ICU to the OR where donation will occur (Miller and Truog, 2012). The apnea test is not performed prior to organ donation because the body’s levels of carbon dioxide increase from 40 torr to a dangerous level of 60 torr (Miller and Truog, 2012). If 60 torr carbon dioxide levels are sustained for a long period, there is irreversible damage to the organs and renders them useless for transplantation (Miller and Truog, 2012). One clinical abnormality pertaining to brain death is the occurrence of the “Lazarus sign” (Miller and Truog, 2012). This phenomenon occurs when the neurons in the spinal cord fire rapidly and cause coordinated muscle contraction and can quite literally cause the patient to sit up in bed (Miller and Truog, 2012). It is due to this “Lazarus sign” that family is asked to step out of the room during testing because it can confuse the family into thinking their loved one is alive and not brain dead