← Guidelines

Brain death determination

Criteria are jurisdiction-specific and the local legal framework governs. The common structure is:

• Prerequisites: a known, irreversible cause; exclusion of confounders — hypothermia, sedative and neuromuscular blocking drugs, severe metabolic derangement, hypotension.
• Clinical examination: unresponsive coma, and absent brainstem reflexes (pupillary, corneal, oculocephalic, oculovestibular, gag and cough).
• Apnoea test: no respiratory effort despite a documented rise in PaCO₂ to an agreed threshold.
• Ancillary testing where any component of the clinical examination cannot be completed or reliably interpreted.