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As a new nurse in the ICU, I'm feeling anxious about being assigned to a patient who's brain-dead. His wife, who seems in shock, has been approached about organ donation. I don't know what she'll decide. Do you have any advice for what to say to a family member at such a terrible time?-B. R., WASH.
Handle this situation with extreme care and sensitivity. Organ donation requires keen awareness of the impact your words can have.
A beautiful 17-year-old boy, Brian, was admitted to our ICU comatose and on life support. Ignoring "no swimming" signs, he'd dived into some murky water, got tangled in a cable, and wasn't rescued for many minutes. Repeated neurologic evaluations, including cerebral blood flow studies, confirmed the diagnosis of brain death.
Paradoxically, Brian, a gifted athlete, was otherwise in superb health, and his organs could save the lives of at least two terminally ill patients. The transplant coordinator asked his parents to consider donating his organs. (Brian's wishes had never been documented.)
His father said no, emphatically.
His mother kissed his hand and wept.
When I was asked to help, the first words I said were, "I am so terribly, terribly sorry that Brian has died."
I didn't talk to Brian's body, nor did I say anything about the machine "keeping him alive." Instead, I asked about their son in the past tense.
'What sports did Brian play?'
"Did Brian like school?"
Those questions encouraged the parents to respond with "did," implying "never again."
Then, "Will you have a big funeral service?"
Using the past tense was an appropriate way to help them grasp that brain death meant just that, their son's death. It isn't a diagnosis that allows you to tell the family, "there's always hope." But some families in these circumstances find that organ donation helps them to make some sense out of the tragedy.
Despite my most carefully chosen words, however, Brian's parents did not, could not.
So perhaps my last words of advice should be, make no judgment.
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