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If you want to know if the clinical lead of organ donation for the NHS (National Health Service) in the in the U.K. can take part in the apnea test for brain death testing, stay tuned. I’ve got news for you.

My name is Patrik Hutzel from intensivecarehotline.com and I have another quick tip for families in intensive care.

So, today, I have an email from Paul who says,

“Hi, Patrik.

Can a clinical lead of organization for the NHS (National Health Service) in the U.K. take part in the apnea test? If not, would it be a legality or a code of practice protected by the law, like brainstem death testing in the U.K.?”

So, me and my team have looked into this, and we’ve done some research, and here is what we found.

In the U.K., the apnea test is a critical component of diagnosing brainstem death, which is legally equivalent to someone being legally dead. This test must be conducted by two senior doctors, neither of whom can be involved in organ donation or organ transplantation. This requirement is part of the Academy of Medical Royal Colleges Code of Practice for the Diagnosis and Confirmation of Death to ensures there is no conflict of interest.

So, next question is, can a clinical lead for organ donation take part in the apnea test?

No, they cannot. A Clinical Lead for Organ Donation (CLOD) works for the NHS Blood and Transplant (NHSBT) and promotes organ donation but is not involved in the actual diagnosis of brainstem death. The Code of Practice prohibits doctors involved in organ donation from participating in brainstem death testing, ensuring the integrity of the process.

Is this a legality or a Code of Practice?

This restriction is based on the Code of Practice for the Diagnosis and Confirmation of Death which is the authoritative guidance in the U.K. Whilst it’s not a law in itself, it’s widely followed and considered legally binding in practice, as failure to comply could result in serious professional and legal consequences.

Additionally, the Human Tissue Act 2004 governs organ donation and ensures that decisions regarding death and organ retrieval are made separately to prevent conflicts of interest.

We also have found out what the latest official guidelines are. So, the Code of Practice for the Diagnosis and Confirmation of Death in the U.K. has been updated as of January 1, 2025. This Code continues to provide authoritative diagnostic criteria for confirming death, ensuring that all deaths are diagnosed and confirmed in an accurate, standardized, and timely manner.

Regarding the involvement of the Clinical Lead for Organ Donation (CLOD) in the apnea test, the updated Code maintains that doctors involved in organ donation or transplantation should not participate in the diagnosis of death, causing neurological criteria. This separation is designed to prevent any potential conflicts of interest and to uphold the integrity of the death diagnosis process.

While the Code of Practice itself is not a law, it is considered authoritative guidance and is widely adhered to within the medical community. Non-compliance with this guidance could lead to serious professional and legal consequences. Additionally, the Human Tissue Act 2004 governs activities involving human tissue, including organ donation, and emphasizes the importance of appropriate consent and ethical practices.

In summary, a Clinical Lead for Organ Donation should not take part in the apnea test as per the Code of Practice to ensure ethical standards and prevent conflicts of interest in the diagnosis of death or brain death.

Paul, I hope that answers your questions and obviously, it sounds to me like you have either a family member in intensive care that is faced with brain death testing or you might even be a clinician working in the NHS and you might have seen questionable ethical approaches here, where maybe a fast track to an organ donation is sought.

From my extensive experience, after having worked for 25 years in critical care nursing in three different countries, that it has to be two independent doctors that I can confirm that cannot be related to the organ donation process. It’s always best to even get one of those doctors coming from another hospital, so that there are no affiliations to the process or to the outcomes whatsoever so that there’s no conflict of interest.

I really hope that answers your question, Paul, and whenever your loved one is in intensive care and, God forbid, needs brain death testing, you might also make sure that you give consent, making sure that there is a standardized and ethical process because you want to make sure that there’s definitely an argument for brain death testing and that it’s not done willy nilly.

When should brain death testing being done?

It should be done when brain death is suspected due to a severe brain injury. According to the Code of Practice for the Diagnosis and Confirmation of Death in 2025, brainstem death testing should be performed under the following conditions: Catastrophic brain injury, the patient must have suffered a severe brain injury due to conditions such as a traumatic brain injury, also known as TBI. Intracranial hemorrhage, i.e., stroke, subarachnoid hemorrhage. Hypoxic brain injury, i.e., after cardiac arrest, or severe infections such as meningitis or encephalitis.

Number 2, there should be no evidence of reversible causes. The medical team must rule out conditions that can mimic brain deaths such as hypothermia, temperature below 34 °C, severe metabolic or endocrine imbalances, drug intoxication, including sedatives, opiates, anesthetics, or neuromuscular blockers. Patient must absolutely be on mechanical ventilation because the brain stem controls breathing, so the patient must be ventilator dependent for a clear diagnosis of brain death.

When should the test be performed?

Testing should be conducted as soon as all prerequisites are met and when it is deemed done after the injury, but doctors must ensure that any potentially reversible conditions have been ruled out. Two senior doctors, neither of whom are involved in organ transplantation, must conduct the tests.

So, if you’ve watched my videos for any length of time, there have been many instances where I said over and over again that hospitals and intensive care teams are sometimes saying to families that your loved one is brain dead when they’re not. They might be brain damaged, but there’s no correlation between brain death and being brain damaged. It is not just wordplay, and there is a clear distinction between someone being brain damaged and someone being brain death, and the two should not be and must not be mixed up.

So, make sure that due process is followed in a situation like that, and it doesn’t matter whether you’re in another country watching this, there’s always due process. Don’t let intensive care teams dictate to you when to do brain death testing, get a second opinion right away, that’s what we do here at intensivecarehotline.com.

I have worked in critical care nursing for 3 different countries where I worked as a nurse manager for over 5 years in critical care nursing, and I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. I can very, very confidently say that we have saved many lives for our families in intensive care. You can verify that on our intensivecarehotline.com testimonial section on our website at intensivecarehotline.com. You can also verify it on our intensivecarehotline.com podcast section where we have done client interviews, who will verify in an interview that we have saved their loved ones’ lives with our consulting and advocacy, because our advice is absolutely life changing.

And because it is life-changing, that’s why we have a growing number of members and clients that want our service and you can join a growing number of clients and members that we are helping instantly when they have a loved one critically ill in intensive care, making sure you make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets best care and treatment always.

That’s why I do one-on-one consulting and advocacy over the phone, Zoom, Skype, WhatsApp, whichever medium works best for you. I talk to you and your families directly. I handhold you through this once in a lifetime situation that you simply cannot afford to get wrong. I also talk to doctors and nurses directly, and when I talk to doctors and nurses directly, I ask all the questions that you haven’t even considered asking but must be asked when you have a loved one critically ill in intensive care.

I also represent you in family meetings with intensive care teams, and you will see that when I represent you or when I talk to doctors and directly, asking all the questions that you haven’t even considered asking, you will see that the dynamics change in your favor very quickly because I know how to hold them accountable, because I speak the medical language, and I understand intensive care inside out.

We also do medical record reviews in real time so that you can get a second opinion, like in a situation like today, you would need a second opinion before you sign off on anything. We also do medical record reviews after intensive care if you have unanswered questions, if you need closure, or if you are suspecting medical negligence.

We also have a membership for families of critically ill patients in intensive care. You can become a member if you go to intensivecarehotline.com, if you click on the membership link, or if you go to intensivecaresupport.org directly. In the membership, you have access to me and my team, 24 hours a day, in the membership area and via email, and we answer all questions intensive care related. In the membership, you also have exclusive access to 21 e-books and 21 videos that I’ve personally written and recorded. All of that will help you to make informed decisions, have peace of mind, control, power, and influence.

All of that, you get at intensivecarehotline.com. Call us on one of the numbers on the top of our website or simply send us an email to [email protected] with your questions.

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Thank you so much for watching.

This is Patrik Hutzel from intensivecarehotline.com and I will talk to you in a few days.

Take care for now.