Brainstem Death

From "UK Transplant" we site
http://www.uktransplant.org.uk/ukt/how_to_become_a_donor/questions/answers/further_info/brain_stem/code_of_practice.jsp?campaign=860#diagnosis


The definition of death should be regarded as `irreversible loss of the capacity for consciousness, combined with irreversible loss of the capacity to breathe'

Conditions Under Which the Diagnosis of Brain Stem Death Should be Considered

1)There should be no doubt that the patient's condition is due to irremediable brain damage of known aetiology

2) The patient is deeply unconscious.

• There should be no evidence that this state is due to depressant drugs
• The patient should be warm i.ePrimary hypothermia as the cause of unconsciousness must have been excluded
• Potentially reversible
  circulatory,
  metabolic and
  endocrine disturbances
  
  must have been excluded.

3)The patient is being maintained on the ventilator because spontaneous respiration has been inadequate or ceased altogether. i.e no drugs such as muscular relaxants/sedatives.

The Diagnosis of Brain Stem Death

1) The pupils are fixed + dilated
2) no corneal reflex
3) vestibulo-ocular reflexes are absent
             (No eye movements are seen during or following the slow injection of at least 50mls of ice cold water over one minute into each external auditory meatus in turn)
4) No motor responses within the cranial nerve distribution
5) no gag reflex
6) No respiratory movements occur when the patient is disconnected from the mechanical ventilator PaCO2  >6.65KPa


AND
The diagnosis of brain stem death should be made by at least

2 Doctors >5 years post registration ( 1 MUST be a consultant and are not members of the transplant team)

Carried out by the two practitioners separately or together.

And repeated the interval between the tests is a matter for clinical judgement.

Although death is not pronounced until the second test has been completed the legal time of death is when the first test indicates brain stem death

Easy no?