Death by neurological criteria & donation
What it means
A patient on a ventilator whose brainstem has irreversibly ceased to function is legally DEAD (death by neurological criteria / 'brainstem death') even though the heart still beats. Diagnosis requires TWO doctors — both registered for ≥5 years, at least one a CONSULTANT, and NEITHER a member of the transplant/donation team (to avoid conflict of interest) — who EACH perform the full set of brainstem-death tests (e.g. pupillary, corneal, oculovestibular, gag/cough, apnoea), on TWO separate occasions. The legal time of death is the FIRST set. This certification (not the MCCD) is what enables organ donation from a heart-beating donor.
Worked example
A ventilated patient after catastrophic brain injury is a potential organ donor; two suitably-senior doctors independent of the transplant team each perform brainstem-death testing twice to certify death by neurological criteria.
In the exam
A ventilated patient in hospital has suffered irreversible loss of brainstem function and is a potential organ donor; the team must arrange the appropriate certification of death for donation to proceed.
What settles it
Death by neurological criteria needs TWO doctors (≥5 yrs registered, ≥1 consultant, NEITHER in the transplant team), each testing twice — this is distinct from the MCCD (one attending doctor certifies the CAUSE of death). The two-doctor rule + transplant context is the exam's favourite.
Classically confused with
Death certification & coroner referral
Source: Code of Practice for the Diagnosis of Death (AoMRC); Human Tissue Act