The guidelines state that to safely diagnose the irreversible loss of brain stem function the patient must satisfy various preconditions as well as have negative brain stem tests. The clinical tests for brain stem function are only valid if considered with various preconditions and exclusions; they are invalid if taken in isolation. The preconditions are as follows and it is their satisfaction which renders the diagnosis of brain stem death safe.
Context: Comatose patient is ventilator-dependent. Known cause for coma. Proof of irremediable structural brain damage.
Exclusions of potential causes of ventilator dependent coma: Hypothermia. Metabolic or endocrine disturbance. Drugs. Recent cardiac arrest.
If just one case arose wherein the guidelines were followed and a patient recovered, I (and assuredly the Royal Colleges) would no longer accept the brain stem formulation of death.
The brain stem death criteria were not introduced for the purposes of human organ donation. Whilst transplantation has benefited from the implementation of these criteria they were developed solely to avoid the extremely distressing scenarios where "corpses" were being ventilated in intensive care units.
Dr M M Jonas FRCA
Nuffield Department of
Oxford UniversityReuse content