Donation after brainstem death

Donation after Brainstem Death (DBD) is possible from patients whose death has been confirmed using neurological criteria (also known as brain-stem death or brain death).

Neurological criteria for the diagnosis and confirmation of death applies in circumstances where brain injury is suspected to have caused irreversible loss of the capacity for consciousness and irreversible loss of the capacity for respiration before terminal apnoea has resulted in hypoxic cardiac arrest and circulatory standstill. This diagnosis is only possible in patients who are on mechanical ventilation.

Figure 1: Potential Donor Audit data from 2012 to 2022, indicating a consistent gap between patients who fulfil the preconditions for brain-stem death testing and those who are tested and whose death is confirmed using neurological criteria. There was a rise in numbers in 2010 as a result of extending the audit to Emergency Department.

Figure 1 - Incidence of brain steam death in the UK 2012-2023
Figure 1 - Incidence of brain steam death in the UK 2012-2023

The current UK Code of Practice for the Diagnosis and Confirmation of Death was published by the Academy of the Medical Royal Colleges (AoMRC) in 2008. This guidance builds upon previous Codes and reaffirms the belief that the diagnosis of death using neurological criteria can be confirmed clinically on most occasions, but acknowledges that clinicians may choose to use a confirmatory or ancillary test on the rare occasions when there may be some uncertainty over the completion or interpretation of clinical examination. Forms for use by clinicians, that are consistent with and used in conjunction with the Code of Practice, have been endorsed for use by the Faculty of Intensive Care Medicine and Intensive Care Society.

Donor Optimisation following consent/authorisation for donation can be very effective in maximising the number and the quality of the organs transplanted. For data on UK DBD visit Potential Donor Audit