When someone is brain-dead, it's the complete and irreversible loss of all brain function—and there is no recovery possible, according to physicians. Although there may seem to be life because of ventilators and equipment, brain death is legally and medically accepted as death.
Here, we break down what brain death is, how it happens, how it is diagnosed, and what it implies for the patient and his or her family—according to expert opinion by medical doctors in Kenya.
What Is Brain Death?
Brain death is explained by Dr. George Biketi, a general practitioner, as the total and irreversible loss of all brain function, including the brain stem.
"Brain death is irreversible," according to Dr. Biketi. "When there is a problem with blood supply or direct trauma to the brain, swelling and tissue damage can lead to complete brain failure, which will ultimately lead to death."
In other words, a person who is brain-dead has absolutely no chance of waking up or getting better. Machines might be capable of keeping the heart and lungs alive for a while, but the brain will never come back to life.
Causes of Brain Death
According to Dr. Biketi, brain death can result from a variety of causes, including:
- Traumatic head injury, i.e., gunshot wound, car accident
- Bleeding in the brain that disrupts oxygenation
- Stroke or cerebral edema
- Prolonged lack of oxygen (e.g., cardiac arrest, drowning)
The brain requires a constant supply of oxygenated blood. Without it, brain cells break down rapidly, resulting in irreversible damage.
How Is Brain Death Diagnosed?
Brain death, according to Dr. Lee Ogutha, a neurosurgeon, is diagnosed by a group of strict clinical tests:
- No response to pain stimulus
- Pupils not reactive to light
- Vision loss
- Absence of brain stem reflexes
- Unable to breathe on their own
If a patient meets these conditions, brain death may be established by a team of doctors—usually in an ICU. The patient is then typically kept on a ventilator, which mechanically maintains heart and lung function for a brief period.
"Despite a ventilator, the patient will not survive without round-the-clock mechanical support," Dr. Ogutha says. "Once brain death has been established, there can be no recovery."
Brain Death vs. Vegetative State or Coma
It's important to note that brain death is different from a vegetative state or coma:
- In a coma, the brain is still somewhat active, and recovery is possible.
- In a vegetative state, patients may have brain stem function and even breathe on their own but are unconscious.
- In brain death, there is no brain activity at all—the body is quite literally being kept alive by machines.
Do Not Resuscitate (DNR) After Brain Death
Once brain death has been confirmed, families are typically asked to sign a Do Not Resuscitate (DNR) order.
"A DNR is not euthanasia," Dr. Ogutha clarifies. "It just means no further efforts are made to keep the body alive, and the patient is allowed to die a natural death."
Euthanasia, or mercy killing—in which life support is actively removed or lethal medication is administered—is illegal in Kenya.
"Mercy killing is against the law in Kenya. Doctors and nurses can't legally switch off ventilators or administer drugs to kill," Dr. Ogutha goes on.
The Organ Donation Role
In some countries, individuals who have been declared brain-dead can be organ donors. Organs such as the:
- Heart
- Liver
- Kidneys
- Corneas
…can be donated if they are still healthy and if the individual had registered as an organ donor prior to death.
Organ donation laws and systems, however, also vary from nation to nation, and Kenya is working on establishing its own systems.
Brain Death Means All Brain Function Comes to an End
Dr. Ogutha emphasizes that brain death means all critical brain function, including in the brain stem, has ceased. Organs like the heart or kidneys can be made to work for a while with support, but the brain will not come back to life.
"I have never seen a brain-dead patient wake up," he says. "In my entire career, once brain death is established, it is always fatal."
Final Thoughts: Knowing What Brain Death Means Helps Families Heal
Brain death is an extremely emotional and challenging diagnosis, particularly for families who are clinging to hope. But knowing what brain death actually is can help families make smart choices regarding end-of-life care and prevent emotional and financial stress.
- Brain death is legally equated to death in the majority of countries, including Kenya.
- Signing a DNR is a compassionate and legally supported act.
- Organ donation can be life-giving to others, if permitted by the law and the patient's wishes.
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