Brain Death

Last week, we declared brain death on one of our patients. I think the last time I broached this topic was when I learned about it as a first year medical student. Brain death is death. A person who is brain dead is dead, and though that is a tautology, it is easy to forget (after all, logicians make careers out of tautology). The patient had a massive stroke and his brainstem had herniated. Before we knew that, we had initiated measures to keep him alive, putting him on a ventilator. But the neurology exam was completely negative; he had no response to pain, fixed pupils, and no brainstem reflexes (oculocephalic, corneals, cough, gag). When we turned the ventilator off, he did not spontaneously breathe. Thus, although we could keep him breathing and his heart beating, he was brain dead, and thus, dead. His family wanted to donate organs, but unfortunately the organ donor network decided not to take his organs (he was over 80 and had some dysfunction of all the organs).

On the other hand, we had a patient who fell and hit his head a week ago. He had a massive head bleed but still preserved some of his brainstem reflexes. Thus, he was not brain dead (and also not dead; since I'm in a logic mood, "if brain dead, then dead" does not imply the inverse, "if not brain dead, then not dead"). The decision to stop the ventilator for this gentleman is much more complicated; since he is alive, withdrawing life support requires a declaration of medical futility or a decision to do so by the durable power of attorney. After several family discussions, we did end up withdrawing life support. Although it is a sad thing, I feel that it was the right choice.