The very public declaration of Usher Raymond’s stepson as brain dead highlights a little understood concept: death is not just defined as the point at which a heart stops beating.
Many media images perpetuate this misunderstanding. Often, they equate death with that characteristic “flat line” and the long, monotone beep that signals that the heart has stopped.
Other images show people in comas or vegetative states, with doctors calling them “brain dead,” as the person looks to be sleeping peacefully, breathing on their own. There is also the miraculous recovery when a person wakes up from a coma after many years. Comas and vegetative states are different than brain death. For one, a brain dead person will never wake up.
In the United States, brain death is one of the legal definitions of death.
Brain death is when the brain irreversibly stops working. This is not limited to the inability to regain consciousness. It also refers to the parts of the brain that control breathing and essential bodily functions. These patients cannot breathe without a ventilator — a machine that helps support a person’s breathing or sometimes breathes for them through a tube placed into the lungs.
The most common ways children become brain dead are traumatic injuries from accidents, brain tumors, or a prolonged lack of oxygen to the brain.
Traumatic injuries can cause swelling of the brain, bleeding that pushes on vital brain structures, or a break in the electrical circuits of the brain. All of these events can cause irreversible damage.
The brain can be deprived of oxygen in several circumstances, including severe infections, dangerously low blood pressure, or suffocation — such as in a drowning or critical asthma attacks. It also happens before the heart starts beating again in a person who needed CPR .
According to reports, Usher’s stepson is currently brain dead after traumatic injuries following a jet ski accident. It’s unclear whether he is in this state from direct head trauma or other internal injuries that caused a decrease in oxygen to the brain.
Some consider brain death a more difficult situation, because the person looks alive, kept that way by machines and tubes, but, technically, they are not.
This is complicated among some religious groups who only accept death as the time when the heart and lungs have stopped working. Certain states, like New York for example, require special accommodations for those families. These religious beliefs, however, are handled differently than families who are just in denial.
Occasionally, the decision is made for the family naturally. Damage to the brain can be so severe that the heart and lungs won’t work even with the machines and medications.
Doctors determine brain death in children with at least two examinations, at least 12 hours apart. It is recommended that two different doctors perform the tests. They check for certain reflexes that the brain should have, including whether the person will have the reflex to breathe after being off of the ventilator.
This evaluation is sometimes backed up with special brain scans to look for blood flow to the brain or tests that check for electrical activity in the brain.
The family then has to choose between continuing care as is, stopping the machines and medications that are artificially keeping the person alive, or donating the person’s organs first.
Some families have donated as many as 20 of their brain dead family member’s organs to others in need. In order to remove any question of conflict of interest, the doctor who harvests the transplant organs cannot be one of the doctors who declares the person brain dead.
If the reports are correct about his condition, the 11-year-old will never regain consciousness. And, Usher’s ex-wife, Tameka Raymond, the child’s mother, will face difficult decisions on how to proceed.
Dr. Tyeese Gaines is a physician-journalist with over 10 years of print and broadcast experience, now serving as health editor for theGrio.com. Dr. Ty is also a practicing emergency medicine physician in New Jersey. Follow her on twitter at @doctorty.