Brain death is a condition when all brain activity stops permanently. People who experience this condition are in a coma and will not regain consciousness.
People with brain death need drugs and assistive devices, such as ventilators, to breathe and keep their hearts beating. The person will not be able to regain consciousness or breathe on their own, because his brain is no longer functioning.
The brain that has died also can no longer regulate the functions of various organ systems of the body. In other words, people who experience brain death can be declared dead.
What Causes Brain Death?
Brain death can occur when the supply of blood or oxygen to the brain stops, so that brain tissue dies and cannot function. This can be caused by several conditions, such as:
- Impaired heart function, such as cardiac arrest and heart attack
- stroke
- Severe head injury
- Brain hemorrhage
- Infections of the brain, such as meningitis
- Brain tumor
- Brain herniation
How Is Someone Declared Brain Dead?
There are several criteria for a person to be declared brain dead, namely:
1. Being in an irreversible coma
Being in a coma doesn't mean brain dead. If it is possible to wake up from a coma, a person cannot be declared brain dead.
To determine whether a person can regain consciousness or not from a coma, doctors must first find out what caused it.
Although rare, there are some conditions that make a person appear to be brain dead, but they are not. Example:
- Hypothermia
- Metabolic disorders
- Poisoning or overdose of drugs, such as drugs and tranquilizers
- Vegetative conditions or vegetative state
2. No reflex
A person is considered brain dead if no brain reflexes are found in his body, such as:
- The eyes are not fixed on the examiner's face when the head is moved left and right
- The pupil of the eye does not shrink when the eye is exposed to light
- Not blinking when the doctor drops water into the eyeball or touches the eyeball with an object, for example cotton bud
- The eyes don't move when ice water is sprayed into the ears
- No cough or gag reflex
3. No breath
To determine whether a person is brain dead, doctors will also monitor breathing and other vital signs, such as pulse or heart rate. A person is said to be brain dead or dead if he can no longer breathe on his own, and his heart is not beating or there is no pulse.
People who have cardiac arrest can also experience this condition, but usually can still be helped if immediately given assistance in the form of cardiopulmonary resuscitation (CPR). Patients with cardiac arrest who are helped after receiving CPR can regain consciousness, breathe on their own, and their heart beats again.
It's different with people who are brain dead. Brain dead patients will not be able to regain consciousness or breathe on their own without the help of a device, even though CPR has been performed many times.
To diagnose and confirm brain death conditions in patients, doctors can perform several supporting tests, such as:
- Electroencephalography (EEG), to measure electrical activity in the patient's brain. In patients who have died, their brain wave or electrical activity is no longer detectable.
- Cardiac electrical examination (EKG), to assess electrical activity and heart rate. People who are brain dead or have died no longer have electrical activity in their heart.
- Imaging tests, such as angiography, CT scan, MRI, and Doppler ultrasound, to determine the condition of the brain and detect blood flow to the brain.
If a person has been confirmed to have brain death or died, the use of drugs or breathing apparatus is actually no longer effective because the condition can no longer be helped.
However, it is sometimes difficult to tell whether a person is brain dead or in a coma due to another medical condition. Therefore, the diagnosis of brain death must be made by at least two doctors, including a neurologist.
Can Brain Dead Patients Become Organ Donors?
Brain dead patients who were previously healthy or have organs that are still functioning properly are candidates for organ donation. In some countries, such as the United States, brain dead patients are even one of the highest sources of organ donors.
In Indonesia, brain dead patients can also become organ donors, as long as certain conditions are met, namely:
- The condition of the organ to be donated is still healthy
- The patient has been declared brain dead by the doctor, usually in the form of a letter or death certificate
- The patient has never suffered from certain diseases, such as HIV, hepatitis B, or malaria
In addition, legally and medically ethical, a brain dead patient can also only become an organ donor if the organ donor procedure has been approved by the patient's family, or by the patient himself before he experienced brain death. This agreement is usually in the form of a written statement (informed consent).
