Death and Donation in Critical Care: The Diagnosis of Brainstem Death

Abstract

1. In the United Kingdom, brainstem death testing can, in the majority of circumstances, be performed at the bedside. 2. Brainstem death testing cannot be contemplated unless drug intoxication, hypothermia, and metabolic and electrolyte disturbances have been excluded. 3. Four vessel cerebral angiography may be helpful in cases of brainstem death testing, where drug intoxication or metabolic disturbance is confusing the clinical picture. 4. Management of the potential heart-beating organ donor requires high- quality critical care, support of the cardiovascular, respiratory, and renal systems, and early commencement of hormonal therapy. 5. In cases of potential controlled donation after cardiac death, analgesia and anxiolysis must not be given simply to accelerate asystole, and thereby facilitate donation.