The patient is brain-dead

Nurse : After her arrival at the Intensive Care Unit, Justine was rapidly intubated. She had a central venous line, arterial catheter, two peripheral venous lines, a nasogastric tube and a bladder catheter. But she had a serious cranial trauma which is irreversible. I’m sorry but her brain lesions are permanent. All her brain functions have come to an irreversible cessation. And unfortunately, there is nothing we can do.

Doctor : I know that you must be shattered and overwhelmed, and have other preoccupations right now, but if you wish, we can talk about organ donation. Have you ever considered such alternative ? Or have you thought of advance directives about end of life ?

Father : What do you mean by advance directives ?

Nurse : It’s a type of written or verbal instructions about health care which have to be followed if a person is unable to make decisions regarding their medical treatment and the possibility of organ donation.

Father : We have never really discussed this subject. Can we choose or decide to whom the organs will be donated ?

Doctor : The law states that this must be done anonymously. This means the identity of the donor and the receiver are confidential. Therefore, you cannot choose whom the organs will be donated to.

Father : I believe that would have been Justine’s choice. But I don’t understand… She is still breathing. It’s as if she’s sleeping.

Doctor : She’s unconscious and she’s not actually breathing. Justine is connected to a life-support system. It’s the machine that is breathing for her. As a result of her injury, the brain has swollen and obstructed its own blood supply. Without blood flow, all brain tissues have died. Being brain-dead means that her brain doesn’t control her organs any more, and her tissues and cells will inevitably die if she’s no longer connected to the artificial respirator.

Father : If we choose to go on with organ donation, how will it be done ?

Nurse : Once you give your approval, your daughter will be transferred to the operating room where we will explant her organs.

Father : Will she feel any pain ?

Nurse : No, not at all. Her brain is dead and doesn’t feel anything nor command any organ. So she will not feel any pain.

Father : And what shall we do, I mean, for the bereavement ritual ?

Nurse : You will be able to say goodbye to Justine before we transfer her to the operating room. You can take her in your arms… Whatever seems suitable for you. After the organ extraction, you will have a personal room in intensive care to watch over her. If you wish, you can also call for a spiritual advisor. And I will stay with you all through the organ retrieval procedure and keep you informed about the operation. I know that you must feel a deep sense of loss. We will give you time to think about it. Feel free to get back to us if you have any question.

Father : All right then. We must think about it first. We will get back to you later.