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Organ Donation

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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?

organ donation

In diagnosing brain death, several tests are typically performed to confirm the absence of brain function. These tests may include:

  1. Clinical Evaluation: This involves a thorough neurological examination to assess the patient’s level of consciousness, cranial nerve reflexes, motor responses, and brainstem reflexes.
  2. Apnea Test: This involves temporarily disconnecting the patient from the ventilator to see if they can breathe spontaneously. If the patient fails to breathe on their own, it suggests brainstem function is absent.
  3. Electroencephalogram (EEG): This measures the electrical activity in the brain. Flat or near-flat EEG readings indicate absence of brain activity.
  4. Cerebral Blood Flow Study: This test assesses blood flow to the brain. Absence of blood flow to the brain indicates brain death.

Once brain death is diagnosed, the procedure typically involves informing the family of the diagnosis and discussing options moving forward, including the possibility of organ donation.

When a patient is determined to be brain dead, the medical team usually approaches the family with sensitivity and compassion. They provide information about the patient’s condition, explain the diagnosis of brain death, and discuss the option of organ donation.

The decision to approach the family about organ donation often falls to members of the medical team who are trained in organ donation procedures, such as transplant coordinators or designated hospital staff.

In the scenario presented, the patient expressed her wish to be an organ donor by indicating it on her driver’s license. However, her mother refuses to consent for organ donation.

Whether donation should proceed despite the mother’s refusal is a complex ethical question. Legally, the patient’s expressed wish to be an organ donor carries weight, but so does the family’s right to make decisions on behalf of their loved one. However, if the patient’s wish was clearly documented and legally binding, and the patient has been declared brain dead, some jurisdictions may honor the patient’s wish for organ donation despite family objections.

The ethical consequences of proceeding with organ donation against the family’s wishes could include potential conflicts with the family, undermining trust in medical decision-making, and possible legal repercussions. It’s important for medical professionals to approach such situations with sensitivity, empathy, and a commitment to honoring the patient’s wishes while also respecting the concerns of the family.

Ultimately, each case must be carefully considered on its own merits, taking into account legal, ethical, and interpersonal factors, with the goal of achieving the best possible outcome for all involved parties.

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