Understanding brainstem death testing

Abstract

Caring for a patient with suspected brain stem death is said to be one of the most challenging nursing roles. There are preconditions a patient must fulfil before brain stem death testing is carried out; different countries have their own brain stem death-testing guidelines. Potentially reversible causes of coma, including metabolic disturbance, hypothermia and depressant drugs, must be excluded, as must high cervical-cord injury if a head injury is suspected. Brain stem reflexes are tested to support the diagnosis and confirmation of brain stem death. Providing relatives with information on brain stem death testing can help reduce the emotional burden on both practitioners and family members. A plan to perform brain stem death testing should trigger urgent referral to the hospital's on-call specialist nurse–organ donation; when relatives are approached about donation by such a specialist practitioner, donation rates are higher. Nurses need to see organ and tissue donation as a normal part of end-of-life care following the death of a patient.