Brain Death Guidelines for Organ Donors

The following information is related to the determination of brain death:

  •  A known cause of death.
  • Absence of hypotension, hypothermia and metabolic abnormalities.
    •  Absence of CNS depressants and drug intoxication.
    •  Clinical examination demonstrating absent cerebral cortex function.
    •  Areflexia.
  •  No response to painful or noxious stimuli.
    •  Clinical examination demonstrating absent brain function.
    •  No pupillary response to light.
    •  No extraocular response to doll's eyes or cold caloric testing.
    •  No response to corneal stimulation.
    •  No cough or gag reflex present.
  •  No spontaneous respirations as demonstrated by an apnea test.
Apnea Test

  •  Normalize pCO2 between 35-45 mmHg.
    •  Pre-oxygenate with 100% FiO2 for 10 minutes.
  •  Disconnect ventilator; give oxygen at 8-12 liters per minute by tracheal cannula.
    •  Observe for spontaneous respirations.
  •  After 10 minutes, draw arterial blood gas (ABG) and reconnect the ventilator.
    •  Patient is apneic if pCO2 is more than 60mmHg and no respiratory effort is made.
    • If hypotension or arrhythmia develops at any time, immediately reconnect the ventilator and consider other confirmatory tests.
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Guidelines for Organ Donation
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