Brainstem death testing in the UK - time for reappraisal?

Background. A diagnosis of brainstem death in the UK is based on clinical assessment rather than technical investigations, but is considered rigorous enough to be legally synonymous with death. Methods. A questionnaire in five sections concerning clinician details, initiation of support, criteria for testing, conduct of the tests, and the process of organ donation, was sent to all members of the Neuroanaesthesia Society. Results. The survey reveals evidence of failure to apply existing guidelines accurately and a wide variation in practice where the recommendations are not specific. Conclusions. In an era of scrutiny of medical process, it is timely to consider whether the current guidelines should be revisited. Clarification of the approach to biochemical derangement, and the role of confirmatory tests when the residual effect of sedative agents cannot be excluded, are two areas worthy of debate.