Understanding brain stem death testing

Caring for a patient with suspected brain stem death is said to be one of the
most challenging nursing roles. There are preconditions a patient must fulfil
before brain stem death testing is carried out; different countries have their
own brain stem death-testing guidelines. Potentially reversible causes of coma,
including metabolic disturbance, hypothermia and depressant drugs, must be
excluded, as must high cervical cord injury if a head injury is suspected. Brain
stem reflexes are tested to support the diagnosis and confirmation of brain
stem death. Providing relatives with information on brain stem death testing
can help reduce the emotional burden on both practitioners and family
members. A plan to perform brain stem death testing should trigger urgent
referral to the hospital’s on-call specialist nurse—organ donation; when
relatives are approached about donation by such a specialist practitioner,
donation rates are higher. Nurses need to see organ and tissue donation as a
normal part of end-of-life care following the death of a patient.