• Waters CE, French G and Burt M (2004). Difficulty in brainstem death testing in the presence of high spinal cord injury. Br J Anaesth. 92: 760-4. Intensive Care Unit, Northampton General Hospital, Cliftonville, Northampton NN1 5BD, UK. In the UK, when the standard brain death criteria are met, further investigations are not necessary. Confirmatory tests can be useful, however, when it is not possible to carry out all of the brainstem tests. We report the case of a patient with multiple trauma and a high spinal cord injury who was apnoeic. Confirmatory tests (EEG, brainstem, auditory evoked potential) were essential in supporting the diagnosis of brainstem death to allow withdrawal of artificial ventilation, as organ donation was being considered.