The clinical diagnosis of brainstem death in children allows withdrawal of life support and may also open up the option of organ donation. Declaration of brainstem death in the UK follows a certain set of examinations as outlined by the code of practice and diagnosis published by the Academy of Medical Royal Colleges. Experiences with non-UK patients within British paediatric intensive care units have highlighted that the code of practice varies internationally and literature reveals that the codes of practice for confirmation of brainstem death in children throughout the world have not been systematically investigated. This paper reports early results on paediatric brainstem death guidelines. We reviewed legal standards and the current clinical literature on 50 countries obtained through personal contacts with physicians. The authors have found significant variation in procedural requirements for diagnosing brainstem death in children between nations, including variations in apnoea testing and number of physicians required to confirm death.