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Brainstem death and organ donation 

Brainstem death and organ donation

Chapter:
Brainstem death and organ donation
Author(s):

M.J. Lindop

DOI:
10.1093/med/9780199204854.003.1709
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date: 30 March 2017

Brain death in the United States of America is defined as the ‘irreversible cessation of all functions of the entire brain, including the brainstem … that are clinically ascertainable’; in the United Kingdom the definition focuses on brainstem function. Half of those who fulfil the necessary clinical criteria will have a cardiac arrest despite intensive treatment within 24 h, and this happens to almost all within 72 h.

Organ donation when brainstem death occurs is well known to the public. In the United Kingdom, under the Human Tissue Act 2004, any known wishes of the patient relating to organ donation are considered paramount.

There are three essential components to the clinical testing of brainstem function prior to the declaration of brainstem death. (1) Preconditions—the diagnosis must confirm irreversible damage; the patient must be in unresponsive coma. (2) Exclusions—reversible causes of coma must be excluded, in particular drug activity, metabolic/endocrine causes, and hypothermia. (3) Clinical criteria—testing must show absence of brainstem reflexes and of spontaneous respiration.

If the patient is brainstem dead and will become an organ donor, the focus of management becomes the care of the potential donor organs.

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