Death is not uncommon in the intensive care unit (ICU); however, situations requiring the diagnosis of brainstem death are relatively rare (,a/ 1989)■ A

significant aspect of the diagnosis of brainstem death is that it is often carried out following an acute event and therefore relatives have usually had only a short time in which to prepare themselves. This is an important consideration when deciding to approach relatives for organ donation, and time must be allowed for the family to understand fully the implications of the tests before such a request is made.

Unless there are medical contraindications, all patients who have been diagnosed as brainstem dead should be considered for organ donation. It is important to establish suitability prior to approaching the family in order to spare them the added stress of addressing this issue when it may be to no avail ( Crombie and Watson

Where there is an established program of organ donation and transplantation, there is usually widespread public awareness and many families may broach the subject spontaneously. Even if the family do not mention organ donation, this is no indication that they would not agree to donate if asked. In either case ICU staff have a duty to carry out the wishes of the relatives and the donor whenever possible.

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