Preconditions
- Diagnosis compatible with brain stem death
- Presence of irreversible structural brain damage
- Presence of apnoeic coma
Exclusions
- Therapeutic drug effects (sedatives, hypnotics, muscle relaxants)
- Hypothermia (Temp >35°C)
- Metabolic abnormalities
- Endocrine abnormalities
- Intoxication
Clinical tests
- Confirmation of absent brain stem reflexes
- Confirmation of persistent apnoea
- Clinical tests should be performed by two experienced practitioners
- At least one should be a consultant
- Neither should be part of the transplant team
- Should be performed on two separate occasions
- There is no necessary prescribed time interval between the tests
Clinical tests for absent brain stem reflexes
- No pupillary response to light
- Absent corneal reflex
- No motor response within cranial nerve distribution
- Absent gag reflex
- Absent cough reflex
- Absent vestibulo-ocular reflex
Test for confirmation of persistent apnoea
- Preoxygenation with 100% oxygen for 10 minutes
- Allow PaCO2 to rise above 5.0 kPa before test
- Disconnect from ventilator
- Maintain adequate oxygenation during test
- Allow PaCO2 to climb above 6.65 kPa
- Confirm no spontaneous respiration
- Reconnect ventilator
Bibliography
Wijdicks E F M. The diagnosis of brain death. N Eng J Med 2001; 344: 1215-1221 |