What is brain death?
When someone is brain dead, the brain no longer works and can never recover. On this page you can read what brain death is exactly and how doctors determine this.
Someone who is brain dead is medically and legally dead. Yet the body may still look 'alive' because machines are temporarily keeping the heart and breathing going. Even so, the person is truly dead and the patient can never recover.
What is brain death?
Someone is brain dead when the brain stops working and will never work again. No more signals are sent from the brain to the body. As a result, the person no longer thinks, feels, or hears anything.
Are you really dead when you are brain dead? In this explainer you will get a clear explanation of what brain death is.
What is the cause of brain death?
Brain death is caused by severe, irreversible damage to the brain. The brain no longer works. That damage can have various causes. For example, it can be caused by a fall, a car accident, or a brain hemorrhage.
What does someone who is brain dead look like?
In someone who is brain dead, the chest still goes up and down. That is because the deceased patient is on a ventilator. This machine blows air with oxygen into the lungs. Then it lets the air out again. In this way, the machine ensures that the lungs still take up oxygen and the heart keeps beating. This ensures that someone still has color and feels warm.
The ventilator ensures that the organs of a brain-dead patient remain suitable for organ donation. This is because the organs receive sufficient oxygen-rich blood, keeping them healthy.
Who determines brain death?
A doctor specialized in the brain, such as a neurologist or neurosurgeon, determines whether someone is brain dead. Someone is only declared brain dead after multiple doctors have checked this via a fixed step-by-step plan. These doctors belong to the patient's treatment team. They are not involved in the transplantation of the organs or in the patients waiting for a donor organ.
The step-by-step plan that doctors follow is very strictly and meticulously drawn up. In every hospital in the Netherlands this is the same. This step-by-step plan is called the Brain Death Protocol and is laid down by law.
The steps in the Brain Death Protocol
What do doctors examine to determine if a patient is brain dead? Read below which steps doctors follow.
Step 1. The doctors examine whether there are still reflexes in the brainstem
Doctors check whether the patient still responds. They do this by performing these steps:
- The doctor shines a light in the patient's eyes to see if the pupils get smaller.
- The doctor strokes the eye to see if there is a blinking reflex.
- The doctor turns the head quickly to see if the eyes move along.
- The doctor injects cold water into the ears to see if the eyes move.
- The doctor moves the breathing tube or suctions the windpipe with a suction device to check if the patient coughs.
If the patient reacts to any of these tests, the person is not brain-dead. The examination is then stopped immediately. Does the person not react to the stimuli from step 1? Then the examination continues.
Step 2. The doctors investigate whether there is still electrical activity in the brain or if blood is flowing through the brain.
The second step of the brain death protocol is to determine whether there is still electrical activity in the brain or if blood is flowing through the brain. Doctors use one of the following examinations for this:
- An Electroencephalography (EEG). This examination measures whether there is still electrical activity.
- A Transcranial Doppler examination (TCD). This examination measures whether blood is flowing through the brain.
- A CT angiography (CTA). This examination measures whether blood is flowing through the brain.
If it turns out that there is electrical activity or blood is flowing through the brain, the examination is stopped immediately. Otherwise, the doctors proceed to the third step of the brain death protocol.
Step 3. The doctors examine breathing using an apnea test
As a final step, the doctor checks whether the patient can still breathe independently. This examination is called an apnea test. The patient is then temporarily taken off the ventilator. Before this happens, the doctor ensures there is enough oxygen in the blood. Afterwards, the doctor turns off the ventilator and watches to see if the patient breathes on their own.
During the test, the doctor measures in the windpipe whether the person is breathing. The oxygen level in the blood is also continuously checked. Is the patient not breathing independently? Then they are brain-dead. That moment of the examination counts as the official time of death for the patient. After the test, the ventilator is turned back on. This keeps the organs in good condition for organ donation.
Frequently asked questions
Are you really dead when you are brain-dead?
Yes, you are truly dead when you are brain-dead. Organs and tissues are only removed when doctors are 100% certain that someone has died. The determination of brain death is done according to strict rules. And multiple doctors are always involved.
Is brain death the same as a coma?
No. Coma and brain death are two different situations. When someone is in a coma, brain activity can still be seen in the brain. When someone is brain-dead, all brain activity has stopped. The brain of someone who is brain-dead does not work and can never work again.
Can you recover from brain death?
No. Once the brain death protocol has been fully completed and brain death has been established, recovery is no longer possible. Brain death is an irreversible condition. This means that someone who is brain-dead has passed away and can no longer recover.