Oct22
Posted by Dr. Riaz Ahmed Syed on Tuesday, 22nd October 2013
Preconditions Diagnosis compatible with brain stem death
Presence of irreversible structural brain damage
Presence of apnoeic coma
Exclusions
Therapeutic drug effects (sedatives, hypnotics, muscle relaxants)
Hypothermia (Temp >35°C)
Metabolic abnormalities
Endocrine abnormalities
Intoxication
Clinical tests
Confirmation of absent brain stem reflexes
Confirmation of persistent apnoea
Clinical tests should be performed by two experienced practitioners
At least one should be a consultant
Neither should be part of the transplant team
Should be performed on two separate occasions
There is no necessary prescribed time interval between the tests
Clinical tests for absent brain stem reflexes
No pupillary response to light
Absent corneal reflex
No motor response within cranial nerve distribution
Absent gag reflex
Absent cough reflex
Absent vestibulo-ocular reflex
Test for confirmation of persistent apnoea
Preoxygenation with 100% oxygen for 10 minutes
Allow PaCO2 to rise above 5.0 kPa before test
Disconnect from ventilator
Maintain adequate oxygenation during test
Allow PaCO2 to climb above 6.65 kPa
Confirm no spontaneous respiration
Reconnect ventilator