Brain death, death by neurological criteria and organ donation: Case

This boy has a catastrophic and irreversible brain injury from the severe traumatic brain injury, and the team is right to consider the determination of brain death. The cause is known and irreversible, the imaging shows the large intracranial haemorrhage and the cerebral oedema, and the intracranial pressure could not be controlled, so the prerequisite of a devastating structural cause is met. The confounders must now be formally excluded before any neurological testing, the examination and the apnoea test performed by two clinicians, and the determination made across the two evaluations separated by the observation period. ^[3]

The prerequisite checks

The prerequisites are the checks that guarantee the examination will be interpretable, and each must be met before any reflex is tested. The cause is the severe traumatic brain injury, which is known, structural and irreversible, confirmed on the imaging and the course. The core temperature is 36.8 degrees Celsius, which is at least 36 degrees Celsius, so the hypothermia confounder is excluded. The systolic blood pressure is 95 mmHg on low-dose adrenaline, which is normal for a 5-year-old, so the hypotension confounder is excluded. The sedation has been off for over 24 hours, the drug screen is sent, the barbiturate level is confirmed therapeutic-zero, the electrolytes and the blood gas are corrected to the normal range, and a train of four confirms the full neuromuscular recovery. ^[1]