Originally Posted by presuppose
I asked a question during an organ recovery inservice; namely, how can we be so absolutely sure the poor soul isn't in a 'locked in' state?
People who are "locked in" typically have preservation of horizontal and vertical gaze, and can blink on command.
To review: probably the most commonly accepted standard of brain death is from the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. It has been summarized elsewhere as:
"The standard tests proposed by the medical consultants to the President's Commission are clinically based. The brain functions considered are cerebral and brain stem functions. Cessation of cerebral function is attested by deep coma without clinical response to any physical stimuli. Brain stem function is assessed by testing for cranial nerve function, including pupillary, corneal, oculocephalic, oculovestibular, and oropharyngeal reflexes, and by carrying out an apnea test to determine respiratory function. Irreversibility is determined by identifying the cause of the coma to exclude drug intoxication and hypothermia and by observing the patient for a specified period of time. Such tests as an electroencephalogram, a brain stem evoked potentials study, or a cerebral blood flow study are considered desirable when objective documentation is needed to substantiate these clinical findings but are not generally necessary for the determination of brain death."
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