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Death and Donation in Critical Care: The Diagnosis of Brainstem Death

  • Paul G. Murphy
Chapter
  • 2k Downloads
Part of the Competency-Based Critical Care book series (CBCC)

Key Points

  1. 1.

    In the United Kingdom, brainstem death testing can, in the majority of circumstances, be performed at the bedside.

     
  2. 2.

    Brainstem death testing cannot be contemplated unless drug intoxication, hypothermia, and metabolic and electrolyte disturbances have been excluded.

     
  3. 3.

    Four vessel cerebral angiography may be helpful in cases of brainstem death testing, where drug intoxication or metabolic disturbance is confusing the clinical picture.

     
  4. 4.

    Management of the potential heart-beating organ donor requires high- quality critical care, support of the cardiovascular, respiratory, and renal systems, and early commencement of hormonal therapy.

     
  5. 5.

    In cases of potential controlled donation after cardiac death, analgesia and anxiolysis must not be given simply to accelerate asystole, and thereby facilitate donation.

     

Keywords

Drug Intoxication Reflex Test Neurogenic Pulmonary Edema Apnea Test Comatose State 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. A code of practice for the diagnosis and confirmation of death. Academy of Medical Royal Colleges (2008) http://www.aomrc.org.uk/
  2. Bell MMD, Murphy PG, Moss E (2004) Brainstem death in the UK – time for re-appraisal. Br J Anaes 92:633–640CrossRefGoogle Scholar
  3. Conference of Medical Royal Colleges and their Faculties in the UK (1995) The criteria for the diagnosis of brainstem death. J R Coll Phys (Lond) 29: 381–382 Google Scholar
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  5. Grattan-Smith PJ, Butt W (1993) Suppression of brainstem reflexes in barbiturate coma. Arch Dis Child 69:151–152CrossRefPubMedGoogle Scholar
  6. Medical royal colleges and their faculties in the United Kingdom (1976) Diagnosis of death. BMJ 2:1187–1188CrossRefGoogle Scholar
  7. Mollaret P, Goulon M (1959) Le coma depassé. Rev Neurol (Paris) 101:3–15Google Scholar
  8. Pallis C, Harley DH (1996) ABC of brainstem death. BMJ publishing group, LondonGoogle Scholar
  9. Wijdicks EFM (2001) The diagnosis of brain death. N Engl J Med 344:1215–1221CrossRefPubMedGoogle Scholar
  10. Yang KL, Dantzker DR (1991) Reversible brain death: a manifestation of amitriptylline overdose. Chest 99:1037–1038CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag London Limited 2010

Authors and Affiliations

  • Paul G. Murphy
    • 1
  1. 1.Department of AnaesthesiaLeeds General Infirmary Leeds Teaching Hospitals NHS TrustLeedsUK

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