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“You are the registrar on the ward, and a 40-year old woman has been admitted with incurable intracranial haemorrhage. The neurosurgeons have said there is no surgical option. He has been on a life support machine and had fluids and sedation. This was stopped over 48 hours ago and he has made no response despite stopping sedation. He has had some brainstem death testing and confirmed there is no neurological function.”

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Your consultant is busy with another patient and you have been asked to explain the diagnosis, brainstem death testing which will be done by the consultants and possible organ transplantation.

The wife is waiting to hear the outcome of the brain testing and what happens next.

This communication skills station relates to a catastrophic intracranial haemorrhage and brainstem death testing and approaching the subject of organ donation.

The doctor goes through all the investigations and the results and the lack of surgical option.

The doctor allows some time for the relative to take this in and express her own views. However, at this point, she should give her a bit more time to understand the diagnosis. Because the aim of the station is to discuss the results of the brainstem death testing, a doctor will often rush to get to the main part of the station, rather than allow the relative to take in the information already given.

The doctor goes through, step-by-step the tests that occur. These can be distressing to communicate.

The final result of this, is that the patient has died. It can be difficult for relatives to understand when a patient’s body is warm and their heart still beats, that they are dead, but this is the skill here, or informing the relative that the brain has no functional capacity, and hence she is dead.

This is the same as any other communication about death, but it is made more complicated by the fact that the patient’s heart is still beating and they are on a ventilator.

When broaching the subject of organ donation, this is a very difficult time, and so it has to be done with some sign-posting of the difficulties in asking this question. Do not push – you do not have to get a definitive answer here, but you can offer to return with someone, such as the transplant nurse coordinator, to talk about the subject again.

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