What is the brain stem?
The brain stem is a small area at the base of the brain. It is responsible for maintaining life – it makes us breath, our heart beat and keeps us conscious.

What is brain stem death?
If the brain stem dies then messages to and from the brain stop. Vital life functions will no longer happen and life cannot continue. Breathing will stop, the heart will not beat and the person will not regain consciousness. When the brain stem dies it cannot recover and the person has died.

When does brain stem death happen?
Brain stem death happens when the brain has been injured. It may be caused by one of the following:
A head injury                          Bleeding into or around the brain                      Drug overdose
Poisoning                              Suffocation                                                            Drowning
When the brain is injured it becomes swollen and because it is enclosed in the skull at some point it cannot swell any more. This puts pressure on the brain stem. When this happens, blood and oxygen cannot reach the brain stem and it dies.

How do you know someone is brain stem dead?
If an injury to the brain has taken place, doctors will monitor the person’s responses and progress. Doctors will then decide if brain stem death tests need to carried out. Two sets of tests are then carried out to check for signs of life. The tests follow strict guidelines. They are carried out by two experienced doctors and are completed twice. The time between the sets of tests can vary depending on circumstances.
The tests are:

Reaction to light -  a light is shone into the eyes to see if the pupils respond

Blink reflex -  a soft object such as a piece of cotton wool is stroked across the eye to see if the person blinks

Response to pain  - pressure is applied to the forehead to see if there is any response to pain

Natural Eye Movement -  a small amount of cold water is poured into the ear to see if this makes the eyes move

Cough reflex -  the back of the throat is stimulated to see if the person coughs or gags

Breathing -  the ventilator that has been breathing for the person is switched off for a short period. This makes the carbon dioxide levels in the body rise.  Usually, the brain would react to this by making the person breathe to get rid of the carbon dioxide.  If the brain stem has died this message cannot get through even if the carbon dioxide levels are allowed to become highter than normal.  The person is monitored to see if there is any attempt to breath on their own. The person is then reconnected to the ventilator.

If the brain stem is dead then there will be no reaction to any of these tests.
If there is a response to any of these tests, the tests are stopped.

Questions?

If my loved one is dead why is their heart still beating?

While the ventilator puts oxygen into the lungs, the heart will continue to beat. Without the ventilator the heart would stop beating. Even with a ventilator the heart will stop beating within a period of hours.

Why is the chest moving and the body warm and pink?

The chest is moving because the ventilator is pushing oxygen into the lungs. The chest expands just like in normal breathing but it is artificial. Because the heart is still pumping blood around the body it keeps it warm and pink.
None of these things mean that the person is alive or will get better.

Do they feel any pain?

No, when someone dies they can no longer feel pain. This is why one of the tests includes a test for a reaction to pain.

Can I stay with my loved one while the tests take place?
Yes. Some people wish to be present, others prefer not to. Talk to the staff caring for your loved one about your wishes and possible options.