Table 1.

Clinical criteria for brain death

Exclude

• Hypothermia (less than 32°C), neuromuscular blocking agents

• Central nervous system depressants (intoxicant, poison, sedative, hypnotic, narcotic, etc.)

• Central nervous system pathology (Locked-in syndrome, Guillain-Barre syndrome, encephalitis, etc.)

• Acute metabolic derangements (Hepatic coma, uremic coma, hypoglycemia, abnormal pH or electrolyte, etc.)

Examination

• Unresponsiveness, absence of cerebral and brainstem functions

• Absence of corneal reflexes and pupillary response to light

• Absence of pharyngeal and tracheal reflexes

• Absence of caloric response

• Absence of respiratory drive at a partial pressure of arterial carbon dioxide that is 60mm Hg, or 20mm Hg above normal base-line values

Interval between two evaluations (by patient's age) for confirmation of brain death

• Term to 2 month old : 48 hours, 2 month to 1 year old : 24 hours, 1 to 18 year old : 12 hours

• Above 18 year old : Interval is optional (As per THOA guidelines it is 6 hours)

Confirmatory tests

• Term to 2 month old : 2 confirmatory tests

• 2 month to 1 year old : 1 confirmatory test

• Above 1 year old confirmatory test is optional (in Indian context it is 6 hours)