Brain-dead: Doctors say rare for patients to recover

A person declared brain-dead does not recover or wake up—they eventually die, according to medical experts.

Dr George Biketi, a general practitioner, explained that brain death is the complete and irreversible cessation of all brain activity.

“Brain death is irreversible. Whenever there is a problem with blood supply or cut damage, a patient reports swelling of the brain, resulting into death,” explained Biketi.

Brain death according to Biketi can be caused by several factors, namely traumatic injury like gun shots and accidents that breaks the skull and brain tissue.

Bleeding can also cause brain death, as it prevents normal circulation of oxygen to the brain and other parts of the body.

For a human to function normally, regular blood supply to the brain is necessary, and lack of oxygen leads to loss of brain function.

“As a practitioner, I have never experienced someone with brain death survive. In all cases that I have experienced, they never survive, they progress to vegetative state (brain and body being unable to function)," explained the practitioner.

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“With brain death, heart beat and respiration may be assisted by a ventilator. A patient in such a condition cannot sustain normal bodily function on their own,” added Dr Biketi.

Neurosurgeon Dr Lee Ogutha emphasised that the brain is an essential organ and must be safeguarded at all costs. Injury to it can lead to paralysis or even death.

Dr Ogutha describes the brain as the body’s central control system.

“Survival without brain function is impossible. In cases of brain death, where the heart may still be beating, the patient has lost all vital brain functions, particularly in the brain stem, and this is usually terminal,” says Dr Ogutha.

In an interview with The Standard, the neurosurgeon reiterated that when a patient is declared brain-dead, the brain function will not come back.

Such a patient is usually on a life support and ventilator, which supports the heart and breathing, and if stopped, death will follow in a few hours.

A patient is declared brain-dead if they do not have any response to deep pain stimulation, their pupils do not react to light, they have lost brain stem reflexes and cannot support breathing on their own.

In a situation where a patient in brain-dead, all other body functions eventually stops, particularly if there is no ventilator support.

If a ventilator supporting an individual declared brain-dead is unplugged, the patient will automatically die.

In his practise, Ogutha said he has never witnessed a patient who is declared brain-dead survive.

“There are cases of individuals declared brain-dead, but they have continued to have mechanical support for a long time. In spite of this, they do not recover,” explained the neurosurgeon.

In a scenario where a patient is declared brain-dead, family or next of kin are advised to consider consenting to-DO NOT RESUSCITATE (DNR) form.

The form is given to the family at the Intensive Care Unit (ICU) after a discussion with a team of doctors and nurses taking care of the patient.

However, he explained DNR is not the same as mercy killing or euthanasia.

“Mercy killing would involve knowingly switching off a ventilator, and or injecting drugs that would cause death, whereas DNR means that additional efforts to sustain and prolong organ functions will not be put in once brain death has been declared, and a patient would be allowed to die naturally,” clarified the neurosurgeon.

In Kenyan law, however, mercy killing is illegal.

“In Kenya, mercy killing is illegal and a doctor and a nurse cannot switch off a ventilator or knowingly give medication to give death,” he said.

Ogutha explained that in a situation where a patient is brain-dead, a DNR save the family a lot of emotional distress and significant financial costs, for a patient who cannot survive.

“If the family consents, and doctors are sure a patient meets brain death criteria, they are allowed to sign Do Not Resuscitate,” he added.

In other countries, an individual who is brain-dead can be a candidate for organ donation.

Example of organs that can donated include heart, liver, cornea and kidneys.

The donated organs should however be in a healthy state, with the patient having previously signed up, to be an organ donor before death.

Further, Ogutha said when brain-death is declared, it means all essential functions of the brain have stopped.

However, other organs like the heart, lungs, kidneys may still be functioning.

When one is declared clinically dead, it means that the brain as well as all other organs are no longer functioning.

Ogutha and Biketi are however not privy about surgery conducted on Boniface Kariuki, who was allegedly shot by a bullet on streets of Nairobi.

Information about the type of surgery conducted on the patient also remains scanty.

Dr Ogutha maintained that brain surgery is a delicate procedure, and survival of a patient depends on the type of injury, and its location.