Physical Examination Criteria a. Coma and apnea must coexist. The patient must exhibit complete loss of consciousness, vocalization, and volitional activity. Drugs may influence and invalidate pupillary assessment. Absence of movement of bulbar musculature including facial and oropharyngeal muscles. The corneal, gag, cough, suckling, and rooting reflexes are absent.
Respiratory movements are absent with the patient off the respirator.
Apnea testing using standardized methods can be performed, but is done after other criteria are met. The patient must not be significantly hypothermic or hypotensive for age. Flaccid tone and absence of spontaneous or induced movements, excluding spinal cord events such as reflex withdrawal or spinal myoclonus, should exist. The examination should remain consistent with brain death throughout the observation and testing period. The recommended observation period depends on the age of the patient and the laboratory tests utilized.