Brain death/death by neurologic criteria determination: an update

Abstract

Purpose of reviewBrain death, also known as death by neurologic criteria (DNC), is a well-established concept. In this article, we present a short history of the concept and give an overview of recent changes and a practical update on diagnosis and definitions of brain death/DNC. Unresolved issues will be discussed.Recent findingsThere is variability in brain death/DNC determination worldwide. In recent years, successful attempts have been made to harmonize these criteria and, consequently, to improve public trust in the process and diagnosis. An international multidisciplinary collaboration has been created and it has published minimum criteria, provided guidance for professionals and encouragement to revise or develop guidelines on brain death/DNC worldwide.SummaryThere are two sets of criteria for declaration of death. First, if there is neither cardiac output nor respiratory effort, then cardiopulmonary criteria are used. Second, if both the cerebrum and brainstem have completely and permanently lost all functions, and there is a persistent coma, absent brainstem reflexes and no spontaneous respiratory effort, death can be declared on the basis of brain death/DNC. Although attempts to formulate uniform criteria are ongoing, consensus has been reached on the minimum criteria. Some inconsistencies and questions remain.

Impact of Decompressive Craniectomy on Diagnosing Brain Death in Children

“…Although most of the current BD diagnostic criteria mainly include neurologic criteria, in different countries, determination of BD requires confirmation of the loss of bioelectrical activity of the brain or a demonstration of cerebral circulatory arrest. 1 Transcranial Doppler ultrasound, CTA, magnetic resonance angiography, nuclear scintigraphy, and conventional angiography are the most common confirmatory tests demonstrating cerebral blood flow. 8 The presence of extraventricular drain, skull defect, or even open fontanel in a newborn may affect the TCD results and have potential inaccuracies in the confirmation of BD with TCD and CTA.…”

“…Brain death (BD) is the irreversible cessation of all functions of the entire brain that results in the clinical findings of coma, apnea, and loss of all tested brainstem reflexes. 1 Brain death is accepted as a medical and legal mode of death in many countries worldwide, including Turkey. Although there are variations in the protocols in different countries, according to the Turkish law, ancillary tests are required with the clinical examination of BD.…”

Beyond the surface: unveiling the complexity of brain death and misdiagnoses in clinical practice

“…The hypothalamus and pituitary gland may become ischaemic, leading to impaired neuroendocrine function. The process reaches its conclusion at the cervicomedullary junction, where the upper cervical spinal cord also sustains an injury 5 , 6 .…”

Brain death and organ and tissue donor management in the Intensive Care Unit

“…• Temperatura inferior a 35 °C Muerte encefálica/muerte por determinación de criterios neurológicos: una actualización. (10) Drost G 2020 PubMed Criterios americanos para diagnosticar ME. El paciente con ausencia irrevocable de todas las funciones cerebrales incluye:…”