collect more information about brain dead organ donation and body donation
Answers
Answered by
10
increased over the last decade with the progress in the field of transplant. The diagnosis of brain death is clinical and can be confirmed by apnea testing. Ancillary tests can be considered when the apnea test cannot be completed or is inconclusive. Reflexes of spinal origin may be present and should not be confused against the diagnosis of brain death. Adequate care for the donor targeting hemodynamic indices and lung protective ventilator strategies can improve graft quality for donation. Hormone supplementation using thyroxine, antidiuretic hormone, corticosteroid and insulin has shown to improve outcomes following transplant. India still ranks low compared to the rest of the world in deceased donation. The formation of organ sharing networks supported by state governments has shown a substantial increase in the numbers of deceased donors primarily by creating awareness and ensuring protocols in caring for the donor. This review describes the steps in the establishment of brain death and the management of the organ donor. Material for the review was collected through a Medline search, and the search terms included were brain death and organ donation.
Keywords: Brain death, organ donation, donor care
Introduction
Brain death is a state of cessation of cerebral function wherein the proximate cause is known and is considered irreversible. The American Association of Neurology (AAN) has defined brain death with three cardinal signs, cessation of the functions of the brain including the brainstem, coma or unresponsiveness and apnea.[1]
In India, the Transplantation of Human Organ Bill was introduced in the Lok Sabha on 20th August 1992 and became the Transplantation of Human Organ Act in 1994.[2] The limited availability of organs amidst a growing demand emphasizes the need for optimal donor care. There is no global consensus in the criteria for establishing brain death, and significant differences exist in the tests used.[3] In many countries, including India, the diagnosis of brain death is made after fulfilling the mandatory criteria and by the apnea testing which is a safe technique for documentation.[4]
In India the deceased donor organ donation rate is only 0.26 per million[5] while USA at 25.6 per million,[6] UK at 18.3 per million[7] and Spain at 32 per million[6] are well ahead.
A checklist of requirements[8] that need to be fulfilled before proceeding with tests for brain death is indicated in Table 1.

Table 1
Checklist prior to proceeding with tests for brain death
Clinical testing for brain death
Coma: Absence of response to noxious stimulus (supraorbital pressure or pressure on the nail bed) with the exception of spinally mediated reflexes.
Absent brain stem reflexes (a formal evaluation of the brain stem reflexes is undertaken when the patient has had fixed dilated pupils and absent cranial nerve reflexes for more than 4 h).[9] Table 2 lists the individual tests for brain stem reflexes.

Table 2
Clinical tests for brain death
Apnea test: The aim of this test is to check for the integrity of the brain stem respiratory center at high levels of blood carbon dioxide. Prerequisites include a patient who is normothermic (core temperature ≥36.5°C), hemodynamically stable (systolic pressure ≥100 mmHg), free from sedative and paralytic drugs, with normal oxygenation (PaO2 ≥200 mmHg after 100% oxygenation) and near normal PaCO2 (35-45 mmHg).
Oxygen is insufflated through a catheter placed at the level of the carina at 6.0 L/min after disconnection from the ventilator. The observer looks for respiratory movements at 8-10 min after disconnection. Assuming a rate of rise in PaCO2 of 3 mmHg/min,[10] this will result in an increase of 24 mmHg above baseline in 8-10 min. The test is considered positive if there are no respiratory movements at a PaCO2 of 60 mmHg or 20 mmHg above baseline in those with an elevated PaCO2 .[9,11] Certification of brain death is after a second apnea testing, the timing of which varies between countries. UK legislation states that the second test can be done at any time after the first when the blood gases have normalized,[12] In the USA, amendments to the earlier guidelines suggest the performance of the apnea test after giving appropriate time for confirming absence of brain recovery and the use of only one apnea test.[13] In India, the apnea test needs to be repeated after an interval of 6 h and certified by four physicians from a recommended panel, one of whom has to be a neurologist. The time of death is the time PaCO2 reaches the target value[1] during the second apnea test.
Keywords: Brain death, organ donation, donor care
Introduction
Brain death is a state of cessation of cerebral function wherein the proximate cause is known and is considered irreversible. The American Association of Neurology (AAN) has defined brain death with three cardinal signs, cessation of the functions of the brain including the brainstem, coma or unresponsiveness and apnea.[1]
In India, the Transplantation of Human Organ Bill was introduced in the Lok Sabha on 20th August 1992 and became the Transplantation of Human Organ Act in 1994.[2] The limited availability of organs amidst a growing demand emphasizes the need for optimal donor care. There is no global consensus in the criteria for establishing brain death, and significant differences exist in the tests used.[3] In many countries, including India, the diagnosis of brain death is made after fulfilling the mandatory criteria and by the apnea testing which is a safe technique for documentation.[4]
In India the deceased donor organ donation rate is only 0.26 per million[5] while USA at 25.6 per million,[6] UK at 18.3 per million[7] and Spain at 32 per million[6] are well ahead.
A checklist of requirements[8] that need to be fulfilled before proceeding with tests for brain death is indicated in Table 1.

Table 1
Checklist prior to proceeding with tests for brain death
Clinical testing for brain death
Coma: Absence of response to noxious stimulus (supraorbital pressure or pressure on the nail bed) with the exception of spinally mediated reflexes.
Absent brain stem reflexes (a formal evaluation of the brain stem reflexes is undertaken when the patient has had fixed dilated pupils and absent cranial nerve reflexes for more than 4 h).[9] Table 2 lists the individual tests for brain stem reflexes.

Table 2
Clinical tests for brain death
Apnea test: The aim of this test is to check for the integrity of the brain stem respiratory center at high levels of blood carbon dioxide. Prerequisites include a patient who is normothermic (core temperature ≥36.5°C), hemodynamically stable (systolic pressure ≥100 mmHg), free from sedative and paralytic drugs, with normal oxygenation (PaO2 ≥200 mmHg after 100% oxygenation) and near normal PaCO2 (35-45 mmHg).
Oxygen is insufflated through a catheter placed at the level of the carina at 6.0 L/min after disconnection from the ventilator. The observer looks for respiratory movements at 8-10 min after disconnection. Assuming a rate of rise in PaCO2 of 3 mmHg/min,[10] this will result in an increase of 24 mmHg above baseline in 8-10 min. The test is considered positive if there are no respiratory movements at a PaCO2 of 60 mmHg or 20 mmHg above baseline in those with an elevated PaCO2 .[9,11] Certification of brain death is after a second apnea testing, the timing of which varies between countries. UK legislation states that the second test can be done at any time after the first when the blood gases have normalized,[12] In the USA, amendments to the earlier guidelines suggest the performance of the apnea test after giving appropriate time for confirming absence of brain recovery and the use of only one apnea test.[13] In India, the apnea test needs to be repeated after an interval of 6 h and certified by four physicians from a recommended panel, one of whom has to be a neurologist. The time of death is the time PaCO2 reaches the target value[1] during the second apnea test.
Answered by
0
Answer:
Brain dead : Brain dead results due to severe irreversible injury to the brain, resulting in inactivity of the brain. However, the functioning of other vital organs can be maintained by an artificial support system. These vital organs can be surgically removed for organ transplantation.
Organ donation : Organ donation is the procedure of donating organs or tissues to a living recipient, who is in need of an organ transplant.
Body donation : It is the donation of the whole body after death for the purpose of science/medical research and education.
Explanation:
I hope it will help you...✍
Similar questions