GuidelinesOther guideline
Brainstem Death Testing Checklist
Brainstem death testing checklist
- 2 doctors required to perform the testing, 1 with > 5 years experience
- Tests may be done by both doctors simultaneously.
- No doctor involved in certification may be involved with the transplant team.
Doctor 1
Name: _______________________
HPCSA Number: _____________
Signature: ___________________
Date: ________________________
Time: ________________________
Doctor 2
Name: _______________________
HPCSA Number: _____________
Signature: ___________________
Date: ________________________
Time: ________________________
| Doctor 1 Sign | PRE-REQUISITES | Doctor 2 Sign |
| Coma, irreversible & cause known | ||
| Normothermia (>35) | ||
| Systolic Blood Pressure >90mm Hg in adults | ||
| Significant metabolic, electrolyte, endocrine abnormality excluded | ||
| Sedative/analgesic/neuromuscular drug effect excluded - In donors with preserved organ function 12 hours sedation-free is adequate |
| Doctor 1 Sign | EXAMINATION | Doctor 2 Sign |
| Pupils fixed & non-reactive | ||
| Absent corneal reflex – cotton wool | ||
| No gag reflex – posterior pharynx stimulation | ||
| Absent cough reflex on deep suctioning down endotracheal tube | ||
| No facial grimace to supra-orbital pain | ||
| Absence of motor response in all limbs (spinal reflexes may persist) | ||
| Oculovestibular (cold caloric) reflex absent bilaterally – 20ml ice water instilled onto intact tympanic membrane whilst eyes held open & observe for nystagmus/pupillary reaction | ||
| Apnoea testing – no spontaneous respiration as per protocol (attach & sign protocol on following page) |
NOTE: Ancillary testing is not required if all of the above criteria are met.
If any doubt the following tests may be indicated: Atropine test, EEG, CT Scan, Cerebral angiogram.
| Doctor 1 Sign | APNOEA TEST | Doctor 2 Sign |
| Page 1 of testing complete & all other criteria for brain death met | ||
| Arterial Blood Gas (ABG) showing normocarbia (PaCO2 35-45mmHg, 4.6-6.0kPa) | ||
| Preoxygenate with 100% FiO2 for 10 minutes | ||
| Disconnect Ventilator & provide oxygen via T-piece (15l/min) or via suction catheter down tracheal tube (6l/min) | ||
| Observe x 10 minutes for spontaneous ventilations |
