General Criteria for Brain Death

 Brain death is defined as the irreversible loss of all functions of the brain, including the brainstem. The three essential findings in brain death are coma, absence of brainstem reflexes, and apnoea.

  1.  Absence of purposive movement
  2.  Flaccid tone and absence of spontaneous or induced movements
  3.  Persistent deep com
  4.  Absence of spontaneous respiration
  5. Absence of brainstem reflexes:

-Midposition or pupils fixed and dilated

- No corneal, gag, or cough reflexes

-Absence of spontaneous oculocephalic (doll’s eye phenomenon) reflex

- No vestibular response to caloric stimulation

6.Isoelectric or flat electroencephalogram (EEG)

7. Absent cerebral blood flow

These criteria vary from state to state.

✍️Hemodynamic management of potential brain-dead organ donors: ensure adequate intravascular volume and adequate cardiac output to ensure consistent perfusion to vital organs

  1. .  MAP >60 mm Hg
  2.  Urine output >1.0 mL/kg/hr
  3.  Left ventricular ejection fraction >45%

✍️Nursing care

  1. Fluid management—fluids or diuretics
  2.  Inotropic agents to correct low cardiac output
  3. Vasopressors to correct vasodilatation
  4.  Thyroid hormone
  5. Corticosteroids to reduce inflammation
  6.  Vasopressin to support renal function
  7.  Insulin to control glucose levels 
  8. Regulate ventilator settings including use of PEEP
  9. Suction frequently to promote adequate oxygenation