Validity of brainstem death criteria

A small minority of clinicians continue to dispute the validity of brainstem death procedures. They claim that it is not legally necessary to diagnose brainstem death in order to discontinue mechanical ventilation and hence that the concept is only required to facilitate organ transplantation. They further suggest that the clinical brainstem tests in routine use are not exhaustive, that they cannot ensure the permanent absence of all brainstem function, and that their satisfaction does not ensure that the brain has been destroyed or that higher brain function has ceased irreversibly. A few have also claimed that there has been no satisfactory 'controlled trial' to assess the prognostic value of the clinical signs of brainstem death. However, a total of over 1000 cases where the patient has been supported after brainstem death has been established clinically have been reported in the world literature. The largest single series was from three neurosurgical centers in the United Kingdom. Asystole was the invariable outcome, usually within a few days.

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