Comment by DoctorOetker | Hacker News Reader

Comment by DoctorOetker | Hacker News Reader

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As an EMT do you frequently witness people being pronounced/determined brain dead? If so what does it look like? I can't imagine an EEG device being attached to each presumed dead patient to double check? Or is that in fact what happens to each patient dying in the care of a hospital?

I am very fascinated about the possible technology involved for monitorinng the state of these organs while the face was being removed. Or am I overimagining and its mostly heart rate, and blood content (oxygen, glucose, what others?) ?

Us normal citizens -seldom in contact with death- we must have an oversimplified view of alive vs dead: atomic (before and after) and monolithic (the whole person is dead, or the whole person is alive), while we are in fact multicellular organisms and some cells have more demanding needs to be met depending on cell type, location in the body, and so on. I can imagine a failing human body prioritizes the functionality of some organs over others?

In the text they mention that donor side and acceptor side can initiate communication through the centralized authority, without obligation to respond, and if they both consent they are allowed to meet each othe as happened here.

Here they had to request explicit permission for the face.

What happens if there was not enough time for properly removing the face yet the donor's next of kin try to ccontact the (non-existent) acceptor? Do they get by policy a "no counterparty response" boilerplate, or are they informed that in fact there was no recipient due to complications?

As EMTs we are trained to provide the best possible care for all of our patients unless very obvious signs of death are present - brain death is not something we really consider because that's something the hospital determines. Obvious signs of death include dependent lividity (blood settling to the lowest point in the body) and decapitation, among other things. EMTs are not qualified to make such judgements in the field (outside of a mass casualty incident and triaging) and opt to be "better safe than sorry" and let someone with an MD after their name and malpractice insurance worry about making the final call. I expect the signs and symptoms of someone with brain death would be indistinguishable from any other apneic unconscious patient without a pupillary response, but some of those can be saved, so we transport them all.

At the hospital, protocols for determining brain death vary depending on the institution, but we have more advanced tools than just EEG now. I see a lot of radiological investigations that measure cerebral metabolism with scintigraphy - here's an example of what that looks like with a poor outcome (I am not a radiologist by any means, and I explored this outside of being an EMT) [1]. Notice how the brainstem is dark but the rest of the brain isn't doing much. Other investigations such as some MRI sequences may prove useful to identify ischemic insults and damage that strongly correlate with poor outcomes. Based on the phrasing of your question, I would point out that these tests would only be performed on a patient where brain death were clinically suspected based on e.g. prolonged cerebral hypoxia from a drug overdose... not every dying patient.

I don't know enough about the medicolegal or surgical side of things to go into more detail there.

[1] - https://img.medscapestatic.com/pi/meds/ckb/59/26659tn.jpg

There's a very interesting New Yorker article on this topic, specifically when it comes to organ transplantation: https://www.newyorker.com/magazine/2018/02/05/what-does-it-m...

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