Brain death criteria The neurological determination of death

Brain death implies the permanent absence of allcerebral and brainstem functions. The diagnosis ofbrain death is usually made clinically. The criteriarequire the occurrence of acute and irreversible CNSinsult. Drug intoxication, poisoning, metabolicderangements, and hypothermia should be correctedfor accurate brain death evaluation. At least 2expert examiners are required to make the braindeath determination. It is advisable to involve anindependent examiner not involved in the patient’scare or the recovery of donated organs. The objectiveof this article is to present updated guidelines for theprocess of brain death determination. All brain andbrainstem functions should be absent on neurologicalexamination including cerebral response to externalstimuli and brain stem reflexes. An apnea test should be performed in all patients. However, if the clinicalcriteria cannot be applied, other confirmatoryancillary tests are required, particularly EEG, andradionuclide scan. They are also needed to supplementthe clinical assessment in young children. An EEG ismore reliable in the setting of hypotension or withdisorders that lower intracranial pressure. Whiletests of brain blood flow are preferred in the settingof hypothermia, metabolic, or drug confounders.