10 Organ Donation Practices and End-of-life Care ... 241setting result from brain death (Senouci 2004 ). This occurs following a
catastrophic cerebral event or injury that leads to the permanent cessa-
tion of brain function. Brain death is indicated by coma, absence of key
brain stem reflexes, and lack of respiratory effort. Once brain death has
been confirmed, the possibility of the patient becoming an organ donor
is raised with the family/whānau. If there is an agreement in favour of
organ donation, the goals of care become oriented towards maintaining
healthy organ functioning and identifying compatibility with potential
organ recipients. This leads to the brain dead organ donor continuing
intensive care treatments, and receiving increased screening, monitor-
ing, and interventions to support the body systems until the organs are
removed (McKeown et al. 2012 ).
Organ donation resulting from brain death can only occur after the
person has been declared dead: the so-called dead donor rule. However,
debates continue about whether death of the entire brain or only spe-
cific parts of the brain determines non-circulatory brain death. As a
result, there are different international definitions in use. In Aotearoa/
New Zealand, Australia and the USA, brain death is defined as cell
death within the brain stem and cerebral hemispheres. In the UK, the
term ‘brain stem death’ is used to describe a state where death of the
brain stem has occurred even though there may be blood flow to the
cerebral hemispheres. Determining brain death is a complex process
that requires a series of tests to ensure a correct diagnosis is made. This
is particularly important given that brain death is distinct from other
conditions, for example a persistent vegetative state where some brain
activity remains.
To ensure clarity and confidence in decisions made in this area,
many countries have professional guidelines and legal standards in
place to guide donor practices (Wijdicks 2002 ). Within these, there is
broad agreement on the presence of irreversible coma, absent motor
response, and absent brain stem reflexes to determine non-circulatory
death. Australasian guidance (Australian and New Zealand Intensive
Care Society (ANZICS) 2013 ) recommends that brain death testing is
undertaken independently by two medical practitioners with specialist
experience and qualifications. To make a diagnosis of brain death, two