Brainstem death has to be diagnosed in those who are on artificial life support and those who harvest organs for transplant

1. Brainstem Death
Kavya Liyanage

2. Brainstem
Death
Moment of death
“Physiological decapitation”
- Christopher Pallis

3. In whom it
is
applicable
?
Those who
on artificial
life support
systems
Those who
are awaiting
for organ
donation for
transplant

4. Brainstem
death -
Importance
When this is proved, patients is dead
Discontinue mechanical life support
Removal of organs for transplantation
can be done

5. How to
diagnose?
Pre-conditions
• Cause for
unconsciousness is not
due to reversible
causes
• Cause for irreversible
cessation of
spontaneous
respiration is not due
to drugs
Clinical criteria
• Absent brainstem
reflexes
• Absent motor
response
• Apnoea tests

6. Cause for
unconsciousn
ess is not due
to reversible
causes
EXCLUDE
• Drug overdose (
e.g.-
Benzodiazepine,
opiates)
• Hypothermia
• Metabolic disorders
• Severe electrolyte
abnormalities
• Endocrine disorders
There has to be
• A natural or
traumatic
• Gross disrupting
lesion
• Of brain or
brainstem
• Sufficient to loss
of consciousness

7. Cause of
irreversible
spontaneous
respiratory
cessation is
not due to
drugs
Eg- suxamethonium – muscle paralysis

8. Clinical
criteria
Absent brainstem reflexes
Absent motor response
Apnoea test

9. Absent
Brainstem
Reflexes
Pupillary reflex
Cornea reflex
Vestibulo-ocular reflex
Gag reflex
Oculo-cephalic reflex

10. Pupillary
reflex
Direct a
bright
light in to
each eye
Observ
e for at
least 60
sec
Pupils -
Fixed
No
reaction to
light
Absent
reflex

11. Pupillary reflex

12. Corneal
Reflex
Gently touch
the cornea
with a sterile
cotton wool
Eyes do not
blink
Absent
reflex

13. Corneal reflex

14. Vestibulo-
ocular
reflex
Inject cold
water to
auditory
meatus
Eyes do not
move
towards the
irrigated
ear
Absent
reflex

15. Vestibulo- ocular reflex

16. Gag reflex
Stimulate the
larynx and
trachea with a
rubber catheter
No cough Absent reflex

17. Gag reflex

18. Oculo-
cephalic
reflex
Grasp the patient’s head between your
hands
Elevate eye lids using thumbs
Rapidly move head side to side through
180 degrees
Eyes move with the head
Eyes do not move within the orbit

20. Absent of
motor
responses
No motor response by
stimulating somatic
area of cranial nerve
distribution
No limb response to
supra orbital pressure

21. Apnoea
test
Ventilate 100% oxygen for 10 mins
Ventilate 5% carbon dioxide for 5 mins
Disconnect ventilator for 10 mins
Repeat the test in2-4 hours
No decerebrate rigidity nor seizure
Persistence of apnoea

22. Apnoea
test should
be done
Twice
By one doctor at each time
• At least one consultant ( preferably anaesthesiologist in charge
of the patient)
• Other one not in the transplant team or harvesting team
• Both should be registered doctors for at least 5 years
• Competent doctors
At an interval of 2 hours
Both times same result
Both doctors should confirm the brainstem death

23. When
brainstem
death is
confirmed
Disconnect the artificial life support
If the organs are to be harvested for
transplant, proceed accordingly

24. ThankYou