https://www.infirmiere-canadienne.com/blogs/ic-contenu/2024/12/02/declaration-du-deces-neurologique
A reminder of the immense importance of empathy, compassion and dignity
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The process a patient undergoes for declaration of death is rigorous and can feel onerous.
Caring for a patient who is undergoing declaration of death by neurological criteria and potential consideration for organ donation is one of the most rewarding and challenging situations for an ICU nurse to experience. It requires the nurse to balance patient-/family-centred care with diligent monitoring of the patient’s hemodynamics, all while supporting the family through the early stages of grief and realization that their loved one has passed.
Courtesy of Marianne M. Rowland
“I hope that this story, besides being informative, helps inform your practice by serving as a reminder of the immense importance of empathy, compassion and dignity during an unimaginably difficult time for the family,” Marianne M. Rowland says.
This article tells a heartwarming story of my experience caring for a patient through the declaration of death by neurological criteria and care of the deceased pending organ donation in an ICU. I hope that this story, besides being informative, helps inform your practice by serving as a reminder of the immense importance of empathy, compassion and dignity during an unimaginably difficult time for the family.
Details of the story have been modified to protect the patient’s identity.
The patient
It’s Sunday morning and I’ve just finished getting the report from the night shift. I view my patient from the foot of the bed and take a deep breath, wondering what today will bring.
Her heart is tracing in a perfect sinus rhythm, not an ectopic beat to be found. Blood pressure stable, no need for inotropes. No sedation hanging despite the 7.5 ETT tube that is secured, 23 cm at the teeth. She looks comfortable, not a sign of pain.
This woman in her mid-50s suffered a catastrophic anoxic brain injury — a result of a choking incident. I held her husband’s hand as I and a wonderful team — including the organ procurement coordinator, the respiratory therapist and two physicians — went through the rigorous testing to confirm what we thought to be true: that this woman had died a neurological death.
The process
The process a patient undergoes for declaration of death is rigorous and can feel onerous. For a nurse, the therapeutic relationship that is fostered with the family walks a fine line between balancing empathy and compassion — with a flicker of hope that the patient may be eligible as an organ donor and be able to save the lives of many.
I join the spouse and the rest of the team required to assess a patient for declaration of death by neurological criteria as we gather in the patient’s room. I sit patiently beside the spouse, my hand resting on his, a therapeutic touch well received by him, as he entangles his fingers in mine.
I fill the silence — the space left vacant as we wait for the news — by describing the beautiful marriage the two shared. I balance the wonderful memories of their great hiking adventures while explaining the details of what the team is assessing, all while fielding phone calls with the laboratory to confirm blood gas results.
The team worked diligently to identify whether the following criteria have been met to declare neurological death (Shemie et al., 2023):
- Neuroimaging showing evidence of catastrophic brain injury with an apparent culpable cause of injury.
- Evidence of no brainstem function by no response to cranial nerve testing.
- Inability of the patient to breathe independently, as evidenced by an apnea test.
- Lack of response to stimuli or lack of any form of wakefulness.
The apnea test can be the longest, 10 solid minutes without the chest rising, with confirmatory arterial blood gases that prove the patient’s PaCO2 levels are greater than 60 mmHg and have climbed greater than 20 mmHg above the patient’s baseline PaCO2 levels (Shemie et al., 2023).
A final love story
The stories the spouse shared with me testify to the great love he had with his spouse. Such conversations come easily for me, and for this I am grateful.
My sincerity and manner remind him of a relative, and my passion for the outdoors makes it easy to connect with this man during such a difficult time.
The final blood gas result is in, and the long wait has come to an end. It’s 12:05 and the patient has passed, death by neurological criteria. I continue to hold the spouse’s hands while he takes in the news. Condolences are shared.
The delicate balance of care requires supporting the family, providing dignity to the patient after death, continuing to ensure vitality of the organs, and anxiously awaiting the arrival of the transplant team to recover the organs, while caring for a patient who still looks very much alive. We support the bereaved, while cautiously hoping that this tragic story may somehow support many individuals to live long, healthy lives.
I monitor the lab work, making sure that all the deceased’s electrolytes are normal. I carefully bathe her, check her IV sites, and reposition her every two hours.
The care expected in the ICU is of utmost importance; others’ lives depend on it.
I reflect on the stories the husband shared in the moments leading up to her time of death. As I look out the beautiful window in the patient’s hospital room, I observe a bald eagle soaring high in the sky and I think to myself, what a privilege it is to be a part of this family’s journey.
Reference
Shemie, S.D., Wilson, L.C., Hornby, L., Basmaji, J., Baker, A.J., Bensimon, C.M, … Rochwerg, B. (2023). A brain-based definition of death and criteria for its determination after arrest of circulation or neurologic function in Canada: a 2023 clinical practice guideline. Canadian Journal of Anesthesia / Journal canadien d’anesthésie, 70, 483–557. https://doi.org/10.1007/s12630-023-02431-4
Marianne M. Rowland, RN, BScN, CNCC(C), is a staff nurse in the critical care unit at Woodstock Hospital in Ontario.
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