BRAIN DEATH AND YNECESSITY OF IDENTIFYING PATIENTS WITH BRAIN DEATH

• 2/12/2020

Death types:

There are two types of death from medical standpoint:

1- Cardiac death constitutes 90% of deaths and all people are aware of it. Accordingly, cardiac arrest occurs. As a result, the patient was died and must be buried.

2- Brain death constitutes 10% of deaths and leads to brain destroy. Cardiac arrest occurs over 1- 14 days. It is not prevalent among people because it occurs in hospital than public places.

Brain death mechanism:

Brain death occurs due to three major events:

1-   Trauma (head injury)

2-   Cerebrovascular accident

3-   Diffuse hypoxia

Any of three factors lead to two types of trauma: Vasculitis and cell swelling.

All of processes lead to Encephalitis that increases intracranial pressure and blocks the main and superficial vessels of brain. Aseptic necrosis begins due to blockage of brains main vessels and non- bleeding over 6-12 hrs. Necrosis destroys brain cells which are irreversible and irreparable cells of body. If we open skull after 3-5 days of brain death, we will observe a soapy and pasty material that is called liquefaction process.

Any factors block bleeding of four main vessels through edema including trauma, vascular problems and lack of oxygen and lead to necrosis. Necrosis destroys brain tissue (brainstem and cortex). Brain dies completely due to irreparability of brain cells. Heart node maintains it electricity like a capacitor after traumatic brain injury. As a result, 6-8 min after brain disorder and no- breathing order, heart beats. If emergency arrives over this time and use Intubation and oxygen therapy by artificial ventilation with the same volume and numbers, heart node will be deceived and continue its activation. As a result, bleeding will be done for 1-14 days and heart will be alive. 

Why does it occur for 1-14 days? Brain tissue necrosis creates corruption within skull. As a person’s hand get Gangrene, they cut his/ her hand in order to prevent toxins contamination; in this case, created toxins lead to necrosis, move downwards and result in cardiac arrest.  

Notes:

Firstly, brain death is a type of death and is not equal to Coma and is one of defined deaths in medical.

Secondly, if family members of person with brain death consent to organ donation, he will save 1-8 persons life through donating 1-8 organs and save 1-35 persons from disability through donating 1-35 tissues.

Question: what are the reasons of organ donation in country?

Previously, people went abroad for transplantation and incurred high costs. Some families get information on transplantation and organ donation and they transferred these information into Iran. Ministry of Health met requirements.

Organ donation unit creates a many lives from a brain death.

The most common reasons and age of brain death in Iran and world

Define patient needing organ:

1-   There is no difference between them and other people in appearance and intelligence.

2-   He/ she is on waiting list of organ transplantation due to inactivity of one main organ (heart, lung, liver, kidney and pancreas).

3-   There is no treatment for his/ her disease anywhere.

4-   The only way to save their life includes organs of people with brain death except kidney, and small part of liver or a lobe of lung that can be transplanted from live person.  

The current status of donation and transplantation in Iran:

Population: 77.000.000 persons

Death due to accidents: 20.000 persons in 2013

5-8 thousands death per year

Donation number: 2500- 4000

Donation number in 2013: 665 persons

Number of persons needing transplantation in country: 7-10 persons daily

Satisfaction statistics in Iran up to 2014 is 37%; that is, 63% of families are not satisfied?

The main reason of organ deficiency in Iran is families’ dissatisfaction for donation. There are two solutions: culturalize in society, improve getting satisfaction

Main solutions:

 Two main solutions of families’ familiarity with brain death concept:

1-   Proper culturalization in society (long term)

2-   Proper training of people who get satisfaction when facing families (short term)

 Metting the necessity of identifying patients with brain death in Ali Ibn Abi Talib Hospital

A 2 hours session was held in meeting room on 01.23.2020 entitled “Necessity of identifying patients with brain death and organ donation” with participation of Tabriz Amir Al Momenin Hospital’s chairman, director, director of nursing office, forensic specialist. Scientific secretary and speaker of meeting was hospital supervisor. The meeting was held after inviting 5 trained transplantation coordinators in Second Special Education Conference on providing transplantation organs of East Azerbaijan province.

Transplantation coordinators of this center:

Mr. Hushmand (CCU matron)

Mr. Mohammadzadegan (emergency matron)

Mrs Rahimi (ICU matron)

Dr. Qabeli (surgery room matron)

Mrs Fekari (training supervisor)

We hope that students, nurses and physicians try to improve organ transplantation culture from patients with brain death in IRAN.

Written by: Zhaleh Fekari, training supervisor

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