Analysis of the reasons for nurses' confusion in relation to the concept of brain death from clinical and legal points of view

Authors

  • Zahra Sadat Manzari Ph.D. of Nursing, Assistant Professor, Department of Medical-surgical nursing, Faculty of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran

Keywords:

Brain death, Organ donation, Nurse, Care, Legal

Abstract

Background: Nurses in intensive care units (ICU) play a key role in taking care of brain dead patients and they
are often in contact with such patients given the high rate of brain deaths. Consequently, they are in a challenging
and stressful condition, which may be aggravated due to the need for increased organ donation, and this may also
affect the quality of care provided for these patients.
Objective: This review analyzes the different studies on the concept of brain death from both medical and legal
points of view. The aim of this study was to identify the challenges the nurses face with the perception of the
concept of brain death and its effects on the care provided for the patients suffering from brain death, as well as
organ donation.
Methods: This Narrative review study summarizes the information obtained from relevant literature through a
targeted search of library texts and electronic resources including Science Direct, PubMed, Google Scholar,
Scientific Information Database (SID), IranMedex, and Magiran databases during 2000-2017 in English and
Persian, on the subject of interest by keywords such as brain death, organ donation, care, legal, regulations and
nursing. Finally, a total of 44 relevant articles were reviewed.
Results: Nurses play an important role in taking care of brain dead patients; therefore, recognizing challenges can
be the first step in taking accurate care of these patients and subsequently maintaining the organs’ health for
transplants. Although there are clinical and legal uncertainties regarding the concept of brain death, nurses have
an important effect on taking care of brain dead patients as well as the rate of organ donation.
Conclusion: Nurses in intensive care units should have a clear understanding of the concept of brain death in
order to be able to take care of brain dead patients by avoiding psychological effects. In this regard, it is
recommended that a comprehensive educational program be designed on the dimensions of brain death.
Therefore, the nurses' awareness of brain death and their ability to clarify this concept to the patients' relatives
would have a great effect on the decrease in the challenges and the stress imposed on the nurses. Also, there
would be an increase in the quality of the care given to brain dead patients and even the rate of organ donation

References

Bosnell R, Madder H. Concepts of brain death. Surgery. 2011; 29(7): 289-94. doi:

1016/j.mpsur.2011.04.001.

Motevalizade S, Zakyaei S. Brain death. J Gorgan Uni Med Sci. 2007; 9(2): 5-6.

Ronayne C. A phenomenological study to understand the experiences of nurses with regard to brainstem

death. Intensive Crit Care Nurs. 2009; 25(2): 90-8. doi: 10.1016/j.iccn.2008.06.001. PMID: 18657425.

Matesanz R. A decade of continuous improvement in cadaveric organ donation: the Spanish model.

Nefrología. 2001; 21(5): 59-67. PMID: 11881417.

Peiffer KM. Brain Death and Organ Procurement: Nursing management of adults with brain injury is

crucial to the viability of donor organs. Am J Nurs. 2007; 107(3): 58-67. doi: 10.1097/00000446- 200703000-00028. PMID: 17314560.

Edwards SD, Forbes K. Nursing practice and the definition of human death. Nursing inquiry. 2003; 10(4):

-35. doi: 10.1046/j.1440-1800.2003.00191.x.

Shabanzadeh A, Sadr S, Ghafari A, Nozari B, Toushih M. Organ and tissue donation knowledge among

intensive care unit nurses. Transplantation proceedings. Elsevier; 2009.

Day L. How nurses shift from care of a brain-injured patient to maintenance of a brain-dead organ donor.

Am J Crit Care. 2001; 10(5): 306-12. PMID: 11548563.

Ozdag N. The nurses knowledge, awareness and acceptance of tissue-organ donation. Edtna Erca J. 2001;

(4): 201-6. doi: 10.1111/j.1755-6686.2001.tb00179.x. PMID: 11902635.

Nicely B, DeLario GT. Virginia Henderson's principles and practice of nursing applied to organ donation

after brain death. Prog Transplant. 2011; 21(1): 72-7. doi: 10.1177/152692481102100110.

Coyle MA. Meeting the needs of the family: the role of the specialist nurse in the management of brain

death. Intensive Crit Care Nurs. 2000; 16(1): 45-50. doi: 10.1054/iccn.1999.1469. PMID: 10790714.

Forsberg A, Flodén A, Lennerling A, Karlsson V, Nilsson M, Fridh I. The core of after death care in

relation to organ donation–A grounded theory study. Intensive Crit Care Nurs. 2014; 30(5): 275-82. doi:

1016/j.iccn.2014.06.002. PMID: 25042694.

Pearson A, Robertson-Malt S, Walsh K, Fitzgerald M. Intensive care nurses’ experiences of caring for

brain dead organ donor patients. J Clin Nurs. 2001; 10(1): 132-9. doi: 10.1046/j.1365-2702.2001.00447.x.

PMID: 11820230.

Broumand B. Transplantation activities in Iran. Exp Clin Transplant. 2005; 3(1): 333-7. PMID: 15989679.

Zohoor AL, Piri Z. Attitudes of Physicians and Nurses of intensive care unit to organ Transplantation with

Brain Dead in Hospitals Affiliated with Iran university of Medical Sciences Tehran 2003. RJMS. 2004;

(39): 97-105.

Abbasi Z, Peyman A. Evaluation of brain death and organ transplantation in Iran Medical Law. Iran J Med

Law; 2012; 6(20): 43-54.

Cebeci F, Sucu G, Karazeybek E. The Roles of Nurses to Augment Organ Donation and Transplantation: A

Survey of Nursing Students. Transplantation Proceedings. 2011; 43: 412-4. doi:

1016/j.transproceed.2011.01.048. PMID: 21440720.

Bernat JL. The concept and practice of brain death. Progress in brain research. 2005;150:369-79. doi:

1016/S0079-6123(05)50026-8.

Floden A, Berg M, Forsberg A. ICU nurses' perceptions of responsibilities and organisation in relation to

organ donation-a phenomenographic study. Intensive Crit Care Nurs. 2011; 27(6): 305-16.

Miller AC, Ziad-Miller A, Elamin EM. Brain death and Islam: the interface of religion, culture, history,

law, and modern medicine. Cاhest. 2014; 146(4): 1092-101. doi: 10.1378/chest.14-0130. PMID: 25287999

PMCID: PMC4188144.

Seraji M. The nature of brain death from the viewpoint of Quran and Hadith. Arak Medical University

Journal. 2011; 13(5): 65-77.

Long T, Sque M, Addington-Hall J. Conflict rationalisation: how family members cope with a diagnosis of

brain stem death. Soc Sci Med. 2008; 67(2): 253-61. doi: 10.1016/j.socscimed.2008.03.039. PMID:

Mirhashemi S. Brain Dead and Transplantion of the Organ of the patient suffering brain Dead. Feghh va

hoghoogh khanevade. 2007; 12(44-45): 114-41.

Sarbey B. Definitions of death: brain death and what matters in a person. J Law Biosci. 2016; 3(3): 743-52.

doi: 10.1093/jlb/lsw054. PMID: 28852554, PMCID: PMC5570697.

DeGrazia D. The Definition of Death. In: Zalta(ed), editor. Stanford Encyclopedia of Philosophy. Stanford

University: Metaphysics Research Lab; 2017.

Cummiskey D. Declaring Death, Giving Life. Eubios Journal of Asian and International Bioethics. 2005;

(3): 70-5.

Shemie SD, Doig C, Dickens B, Byrne P, Wheelock B, Rocker G, et al. Severe brain injury to neurological

determination of death: Canadian forum recommendations. CMAJ. 2006; 174(6): S1-12. doi:

1503/cmaj.045142. PMID: 16534069, PMCID: PMC1402399.

Salahuddin N, Shafqat S, Mapara S, Khan S, Siddiqui S, Manasia R, et al. End of life in the intensive care

unit: knowledge and practice of clinicians from Karachi, Pakistan. Intern Med J. 2008; 38(5): 307-13. doi:

1111/j.1445-5994.2007.01595.x. PMID: 18402559.

Simpson P, Bates D, Bonner S, Costeloe K, Doyal L, Falvey S, et al. A Code of Practice for the Diagnosis

and Confirmation of Death. London: GB Academy of Medical Royal Collages; 2008.

Yazdimoghaddam H, Manzari ZS. Training; a golden ring for removing nurses’ challenges in caring

process of the brain death patients. Hayat. 2017; 23(2): 100-5.

Sotoudeh H, Kalhornia Golkar M. Brain Death: From Nature to Juridical-Legal Effects. Medical Law.

; 6(22): 113-50.

White G. Intensive care nurses' perceptions of brain death. Aust Crit Care. 2003; 16(1): 7-14. doi:

1016/S1036-7314(03)80023-1.

Keshtkaran Z, Sharif F, Navab E, Gholamzadeh S. Lived Experiences of Iranian Nurses Caring for Brain

Death Organ Donor Patients: Caring as “Halo of Ambiguity and Doubt”. Glob J Health Sci. 2016; 8(7):

-92. doi: 10.5539/gjhs.v8n7p281. PMID: 26925919, PMCID: PMC4965685.

Marck CH, Weiland TJ, Neate SL, Hickey BB, Jelinek GA. Australian emergency doctors' and nurses'

acceptance and knowledge regarding brain death: a national survey. Clinical transplantation. 2012; 26(3):

-60.

Kima JR, Elliotta D, Hyde C. Korean health professionals’ attitudes and knowledge toward organ donation

and transplantation. Int J Nurs Stud. 2004; 41: 299-307. doi: 10.1016/j.ijnurstu.2003.10.003. PMID:

Flodén A, Forsberg A. A phenomenographic study of ICU-nurses’ perceptions of and attitudes to organ

donation and care of potential donors. Intensive Crit Care Nurs. 2009; 25(6): 306-13. doi:

1016/j.iccn.2009.06.002. PMID: 19608419.

Cohen J, Ami SB, Ashkenazi T, Singer P. Attitude of health care professionals to brain death: influence on

the organ donation process. Clinical transplantation. 2008; 22(2): 211-5. doi: 10.1111/j.1399- 0012.2007.00776.x. PMID: 18339141.

Rittner CK, Besold A, Wandel E. A proposal for an anonymous living organ donation in Germany. Legal

Medicine. 2003; 5: S68-71. doi: 10.1016/S1344-6223(02)00126-8.

Yousefi AR, Ziaee ES, Ghajaee F, Azarbarzin M. Brain death and transplant organs from the perspective of

jurisprudence,ethics and law and its impact on medical education. IJME/Special issue for educational

development and health promotion. 2012; 11(9): 1366-75.

Tan HM, Wilson A, Olver I, Barton C. The experience of palliative patients and their families of a family

meeting utilised as an instrument for spiritual and psychosocial care: A qualitative study. BMC Palliat

Care. 2011; 10: 7. doi: 10.1186/1472-684X-10-7. PMID: 21435259, PMCID: PMC3073937.

Published

2021-12-24

Issue

Section

Articles