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