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