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Traumatic Brain Injury
Traumatic brain injury (TBI) is a significant cause of brain death, with the majority of victims being between 18 – 49 years of age, and also provides an important source for organ transplantation. The definition of the physiological condition of “brain death” varies throughout the world. In the U.S. a clinical diagnosis of brain death is made when there is no neurological function in a patient who is warm, has a mental status that is not impacted by sedating or paralyzing medication, and who is completely resuscitated with a SBP greater then 90 mm Hg and Spo2 greater then 90%. Legal and ethical issues remain regarding how much of the brain must be dead before the “person” is gone. Various hospitals and health care systems thoughout the country have different methods for declaring brain death and individual states also have varying legal statues for such a declaration. Brain death is a physiological event where the heart and lungs still function usually through artificial respiration. Evaluation of neurological function ensures there is no cortical function, no response to deep pain, non reactive pupils, absence of corneal reflex, and no response to cold caloric stimulation. The patient must also have an absence of any effort to breathe with PaCO2 greater then 60 mm Hg, adequate PO2 (by apnea test), and no gag or cough reflex. Further confirmation can be made by radionucleotide CBF studies or electroencephalography EEG. The individual who has suffered brain death may save the lives of others by organ transplantation. The heart, lungs, liver, kidneys, pancreas and cornea are transplantable and can benefit others who have chronic or acute illnesses. The families of traumatic brain injury victims can only have confidence and trust that the decision for organ transplantation is right when they are sure that all efforts to resuscitate the injured brain have been made. It is the responsibility of the health care team to make every effort to ensure that families have a clear understanding of the issues and what brain death means. This understanding will help families make the best decision regarding organ donation, a decision they can live with.
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