Brain death

Question 1

What are the accepted clinical criteria for brain death

Answer 1

1. Unresponsive: GCS 3/15
2. TOFC 40mV to rule out neuromuscular blockade
3. Absent Brainstem reflexes
4. Apnoea test positive
5. Two doctors - independent with > 5 years experience

Question 2

How is the apnoea test performed

Answer 2

1. Preoxygenate
2. Disconnect ventilator –> PaCO2 > 8.0 kPa and pH <7.3
   OR
   increase in PaCO2 by 2.6 kPa if COPD/CO2 retainer

If no breath is taken at this point = positive apnoea test

Question 3

When is the time of death declared after brain death testing

Answer 3

After the second examination