Diagnosis of Brain death

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The brain is so fundamental that when the brain is dead, the person cannot function without a life support machine and usually dies within a few days. In brain death, all the brain stem functions, including those that maintain breathing, stop working.

The diagnosis of brain death involves making a distinction between severe brain damage and the complete absence of brain function. The decision that there is brain death is made only after certain very critical points have been checked. These are:

There is no question of deep intoxication from drugs, poisons or other chemical agents.
The condition is not due to the effects of paralysing drugs.
It is not the result of lowered body temperature (hypothermia).
There is no question of any neurological condition that could simulate brain death.
There are no spontaneous breathing movements.
The pupils are round or oval and dilated 4-6mm.
The pupils do not change size when a bright light is projected into them.
There are no reflex responses above the neck: no response to corneal contact (touching the surface of the eye), no gag reflex when the back of the soft palate is touched, no coughing in response to tube suction of the windpipe.
There are no eye movements when the outer ear canal is irrigated with warm or cold water (caloric test).
The electroencephalogram shows no sign of electrical activity in the brain, as recorded from a minimum of eight points. All channels must be flat. An electroencephalogram (EEG) is a multiple tracing, made by voltmeter-operated pens, of the electrical activity of the brain.