Brain Death Guidelines Explained

Abstract

Brain death is diagnosed in the minority of patients with acute severe brain injury. Guidelines have been developed in many countries in the world and physicians usually work through a set of criteria. The clinical evaluation starts with determination of futility of any medical or surgical intervention and an unmistakable certainty that the underlying diagnosis is correct. The actual neurologic evaluation in a patient suspected of being brain dead requires 25 tests and verifications. Brain death determination demands perfect diagnostic accuracy and thus requires skill and expertise. The overriding principle is simple: establish cause, exclude confounders, determine futility of interventions, examine brainstem reflexes, and test for apnea. In this review, the author revisits the American Academy of Neurology guidelines, and examines the details behind the guidelines. The 2010 guidelines have eliminated unnecessary tests and observation delays, and maintain a principle of simplicity.

Trans-cranial Doppler as an Ancillary Study Supporting Irreversible Brain Injury in a Post Cardiac Arrest Patient on Extracorporeal Membrane Oxygenation

“…Evidence of irreversible brain injury on neuroimaging is an essential pre-requisite to diagnosing death by neurological criteria [ 1 , 5 ]. Typically neuroimaging is obtained to support the clinical impression of irreversibility of brain injury since clinical neurological examination and apnea testing can be confounded by many medical and pharmacological factors [ 6 ].…”

Optimization of conditions for apnea testing in a hypoxemic brain dead patient

“…( 1 ) The test should be stopped whenever the following is observed: (1) respiratory movements (negative apnea test), (2) hemodynamic instability, or (3) severe hypoxemia. ( 1,3,4 )…”

The Process of Organ Donation from Non-Living Donors: A Case-Based Journey from Potential Donor Identification to Organ Procurement

“…Expertise in determining brain death can be inadequate due to multitude of factors, including lack of clinical experience. This is likely one of the reasons why 6 US states require confirmation by a second examiner and some specifically require at least one of these examiners to be either a neurologist, neurosurgeon or intensivist [73].…”

“…As one can see, the determination of brain death can be quite complex in and of itself and can be even further complicated when the question of organ donation is raised. This is why we stress the importance of early involvement of a local OPO [73]. After the declaration of BD, assuming the presence of consent for organ and tissue donation, the care of the donor shifts to optimizing organ perfusion and viability [7].…”