Criteria for brain death:
(1) underlying process is irreparable with available therapies
(2) no spontaneous movements
(3) no spontaneous respirations during an observation period of 4 minutes (off the respirator)
(4) absent brain stem reflexes (see below)
(5) all of the above remain unchanged for >= 12 hours
Status of brain stem reflexes in brain death:
(1) dilated and fixed pupils
(2) absent corneal reflexes
(3) absent ciliospinal reflexes
(4) absent Doll's head phenomenon
(5) absent gag reflex
(6) absent vestibular response to caloric stimulation
(7) absent tonic neck reflex
Additional comments (both of which differ from the Harvard criteria):
(1) EEG monitoring is not mandatory if all of the above are present.
(2) Spinal reflexes do not have any bearing on the diagnosis of brain death.
