Death by Neurologic Criteria, Donation and Moral Residue
Brain death is legal death, which is why the words you use at that bedside matter: “he died” and “the ventilator” — never “life support.” Run the prerequisites, the brainstem exam and the apnoea test and watch a skipped prerequisite invalidate everything; separate four states that look alike to a family; sequence a donation referral with decoupling intact; then name what this work is doing to you and what actually fixes it.
Prerequisites — before any examination
Brainstem examination — tick what is documented ABSENT
Apnoea test
Set the four axesA family watching a patient with open eyes and a sleep–wake cycle will tell you he is “in there.” These four findings are what separate the states — and what separates dead from alive.
Sequence the referralA ventilated 24-year-old with a devastating head injury. Put the six steps in the order they must happen. Two of them being adjacent is the error that costs families their consent and their peace.