[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › [Critical care](https://durgical.com/en/nursing/areas/critical-care/) › The potential organ donor: brain death in Colombia, keeping the donor stable and the nurse's role in donation # The potential organ donor: brain death in Colombia, keeping the donor stable and the nurse's role in donation - Safe practice After brain death is diagnosed, the nurse keeps the donor's organs working and supports the family, while the hospital alerts the donation network. Updated Nov 13, 2026 ## Key points - Decree 2493 of 2004, art. 12: seven signs — no spontaneous breathing, persistently dilated pupils, no pupillary light reflex, no corneal reflex, no oculovestibular reflex, no gag reflex, no cough reflex. - Brain death cannot be diagnosed while toxic or reversible metabolic causes, CNS depressant drugs or muscle relaxants, or hypothermia are present. - The diagnosis is made by two or more independent physicians who are not part of the transplant programme, one a neurology specialist, and recorded with date and time. - Keeping the donor on artificial support does not invalidate the diagnosis (art. 13). - Donor goals in one review: heart rate 60–120 per minute, mean arterial pressure above 60 mmHg, temperature 36–38 °C and a good urine output. ## What it is In Colombia, Decree 2493 of 2004 defines brain death as the irreversible absence of brainstem functions shown by clinical examination, and sets how it is diagnosed. Once it is confirmed, the person has died, and keeping the body on artificial support to preserve the organs does not change that diagnosis. The hospital must report every potential donor to the regional donation and transplant network at once. As the brain dies, a catecholamine storm is followed by low blood pressure, diabetes insipidus, temperature loss and lung injury, so the nurse's careful monitoring decides whether the organs can be used. The rules on presumed consent and opting out are in Law 1805 of 2016 (see the ethics page on the donation law). ## What it requires - Art. 12, paragraph: if one of the seven signs cannot be checked, a confirmatory test is required. - Art. 14: children under two years have their own criteria, with observation periods and repeated examinations. - Art. 23: the institution where there is a potential donor must notify the regional donation and transplant network immediately. - As the brain herniates, a catecholamine surge (severe hypertension and tachycardia) is followed by vasodilation, low cardiac output and low blood pressure. - Diabetes insipidus and hypernatraemia are frequent after brain death; high sodium is a risk for the liver graft. ## How it is applied (and why) - Report, by the institutional alert, a devastating brain injury that may progress to brain death — early notice keeps donation possible. - Make sure no reversible cause is present before the tests: temperature, sedatives and muscle relaxants, metabolic values — they can imitate brain death. - Assist the physicians during the clinical examination and the apnoea test, and record date, time and results — the law requires a written record. - Monitor heart rate, arterial pressure, temperature and urine output continuously and report deviations from the goals — instability damages the organs. - Measure urine every hour and report a sudden large urine output — it suggests diabetes insipidus and loss of water and sodium. - Keep the temperature within the goal with blankets or warming devices — hypothermia harms the organs and also prevents the diagnosis. - Continue lung care: head raised, airway suctioning and recruitment after any disconnection as ordered — the lungs are fragile organs to donate. - Keep hygiene and skin care — tissues can also be donated, and dignity continues. - Support the family with clear words: brain death is death, and the support only keeps the organs working — mixed messages create doubt and distress. ## In nursing practice - Hypovolaemia is frequent at brain death and is corrected first; the team chooses the fluids and any vasopressor. - The death certificate in brain death is issued by one of the treating physicians or the forensic physician. - The information about the donor, the recipient and the donation process is confidential. ## Common mistakes - Telling the family the patient «is being kept alive» after brain death is confirmed. - Starting the tests while the patient is cold or still sedated. - Letting the urine output, temperature or blood pressure drift without reporting. - Delaying the notification to the donation network. ## Test yourself Think of the answer, then tap the question to see it. ## How many clinical signs does Decree 2493 of 2004 require for brain death in people older than two years? Seven: no spontaneous breathing, persistently dilated pupils, no light reflex, no corneal reflex, no oculovestibular reflex, no gag reflex and no cough reflex. ## Which conditions prevent the diagnosis of brain death? Reversible conditions that imitate it: toxic or metabolic causes, CNS depressant drugs or muscle relaxants, and hypothermia. ## Who makes the diagnosis of brain death in Colombia? Two or more independent physicians who are not part of the transplant programme, one of them a neurology specialist. ## What does a sudden large urine output suggest in a brain-dead donor? Diabetes insipidus, with loss of water and a rise in sodium, which the nurse reports at once. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/nursing/the-potential-organ-donor-brain-death-in-colombia-keeping-the-donor-stable-and-t/) ## Elsewhere in DurgiPedia - [Brain death: the ethical and legal criteria in Colombia](https://durgical.com/en/medical-ethics/brain-death-the-ethical-and-legal-criteria-in-colombia/) - [Ley 1805 de 2016: presumed consent for organ donation](https://durgical.com/en/medical-ethics/ley-1805-de-2016-presumed-consent-for-organ-donation/) - [Diagnosing death: the signs of death](https://durgical.com/en/forensic-medicine/diagnosing-death-the-signs-of-death/) ## Connections ## Related 2 - [End of life in the ICU: limitation of therapeutic effort, withdrawing the ventilator and comfort care](https://durgical.com/en/nursing/end-of-life-in-the-icu-limitation-of-therapeutic-effort-withdrawing-the-ventilat/) - [The family in the ICU: needs, flexible visiting, information, family conferences and presence during resuscitation](https://durgical.com/en/nursing/the-family-in-the-icu-needs-flexible-visiting-information-family-conferences-and/) ## Related conditions 1 - [Coma and brain death](https://durgical.com/en/conditions/coma-and-brain-death/) [← All of nursing](https://durgical.com/en/nursing/) Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order. Sources: [Decreto 2493 de 2004 (componentes anatómicos; diagnóstico de muerte encefálica), Gestor Normativo](https://www.funcionpublica.gov.co/eva/gestornormativo/norma.php?i=14525) (Departamento Administrativo de la Función Pública, Colombia, 2004); [Management of the brain-dead organ donor](https://pmc.ncbi.nlm.nih.gov/articles/PMC8445737/) (Indian Journal of Thoracic and Cardiovascular Surgery, 2021); [Nursing Fundamentals (Open RN), 17.5 Nursing Care During the Final Hours of Life](https://med.libretexts.org/Bookshelves/Nursing/Nursing_Fundamentals_(OpenRN)/17%3A_Grief_and_Loss/17.05%3A_Nursing_Care_During_the_Final_Hours_of_Life) (Open RN, Wisconsin Technical College System (LibreTexts, CC BY 4.0), 2021). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/nursing/the-potential-organ-donor-brain-death-in-colombia-keeping-the-donor-stable-and-t/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/the-potential-organ-donor-brain-death-in-colombia-keeping-the-donor-stable-and-t/