Brain stem death

The correct diagnosis of brain stem death allows discontinuation of futile ventilation and enables potential retrieval of organs for donation. Diagnosis of brain stem death is usually followed by asystole within a few days. Before brain stem function testing can be performed to confirm the diagnosis the patient must have an underlying diagnosis compatible with brain stem death. They must be comatose and non-responsive for at least 6h and there should be a minimum of 2h following a cardiac arrest. There must be no hypothermia (temperature >35°C), evidence or suspicion of depressant drugs, significant metabolic abnormality or muscle relaxant effect. The performance of brain stem death tests should not proceed until relatives and all medical and nursing staff involved with the patient have had a chance to take part in discussions, although the test itself does not require consent. Cessation of mechanical ventilation is seen by many lay people as the final point of death. Clearly, this final step is easier if all are aware that it is to happen. If organ donation is considered, the transplant coordinator should be involved at an early stage.

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