What is brain death?
When someone is brain-dead, the brain no longer functions and can never recover. On this page, you can read what brain death entails and how doctors determine it.
Someone who is brain-dead has passed away both medically and legally. However, the body may still look 'alive' because machines temporarily keep the heart and breathing going. Even so, the person is truly deceased and the patient can never recover.
What is brain death?
A person is brain-dead when the brain stops working and will never function again. No signals are sent from the brain to the body anymore. As a result, the person no longer thinks, feels, or hears anything.
Are you really dead when you are brain-dead? This explainer provides 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 functions. This damage can have various causes. For example, it can result from 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 moves up and down. This is because the deceased patient is hooked up to a ventilator. This machine pumps air containing oxygen into the lungs and then lets the air out again. In this way, the machine ensures that the lungs continue to absorb oxygen and the heart keeps beating. This gives the person color and makes them feel warm.
The ventilator ensures that the organs of a brain-dead patient remain suitable fororgan donation. This supplies the organs with 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. A person is only declared brain-dead after multiple doctors have verified this using a strict protocol. These doctors are part of the patient's treatment team. They are not involved in organ transplantation or in patients waiting for a donor organ.
The protocol that doctors follow is very strict and meticulously designed. It is the same in every hospital in the Netherlands. This protocol 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 become smaller.
- The doctor strokes the eye to see if there is a blinking movement.
- The doctor quickly turns the head 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 needs to cough.
If the patient responds to any of these tests, the person is not brain dead. The examination is then stopped immediately. Does the person not respond to the stimuli from step 1? Then the examination continues.
Step 2. The doctors examine whether there is still electrical activity in the brain or blood 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 blood 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 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 with an apnea test
As a final step, the doctor checks whether the patient can still breathe on their own. This test is called an apnea test. The patient is then briefly taken off the ventilator. Before this happens, the doctor ensures there is enough oxygen in the blood. Then the doctor turns off the ventilator and checks 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. Does the patient not breathe on their own? 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 once doctors are 100% certain that someone has died. Determining brain death is done according to strict rules. And multiple doctors always observe.
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 is still visible 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 diagnosed, recovery is no longer possible. Brain death is an irreversible condition. This means that someone who is brain-dead has died and can no longer get better.