Materiały źródłowe

• #1 Diagnosis of brain death – UpToDate

  https://www.uptodate.com/contents/diagnosis-of-brain-death

  INTRODUCTION AND DEFINITION […] Death is an irreversible, biologic event that consists of permanent cessation of the critical functions of the organism as a whole. This concept allows for survival of tissues in isolation, but it requires the loss of integrated function of various organ systems. Death of the brain therefore qualifies as death, as the brain is essential for integrating critical functions of the body. The equivalence of brain death with death is largely, although not universally, accepted. […] Brain death implies the permanent absence of cerebral and brainstem functions. Although the term „brain dead” is often used colloquially in a way that erroneously encompasses patients with severe brain damage and those who remain unresponsive, in medical-legal terms its meaning is very specific.

• #2 Brain death: a clinical overview | Journal of Intensive Care | Full Text

  https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-022-00609-4

  Brain death, also commonly referred to as death by neurologic criteria, has been considered a legal definition of death for decades. […] In 1980, the Uniform Determination of Death Act established a legal basis for a neurologic determination of death in the U.S., and adult guidelines were put forth in the 1995 (and revised 2010) American Academy of Neurology (AAN) guidelines on the determination of BD/DNC. […] In practice, diagnosis of BD/DNC is essential to organ transplantation, particularly cardiac, in that brain dead donors are the only accepted source for cardiac transplant in the United States. […] The first and most widely accepted is the whole brain formulation which asserts that brain death is equivalent to catastrophic injury to all the major structures of the brain including the hemispheres, diencephalon, brainstem, and cerebellum.

• #3 Diagnosis of brain death – UpToDate

  https://www.uptodate.com/contents/diagnosis-of-brain-death

  Brain death signifies the complete, irreversible cessation of brain function, including the capacity for the brainstem to regulate respiratory and vegetative activities. It was first described in 1959, predating widespread organ donation, which has since made its codification critically necessary. While most countries have a legal provision for brain death, institutional protocols for diagnosis are not universal and are often absent, particularly in lower-income countries and in those without an organized transplant network. Even among countries with an organized diagnostic protocol, there is substantial variation in the criteria that are used. […] While United States law equates brain death with cardiopulmonary death, specific criteria for diagnosis are not mandated. Some states and institutions have specific diagnostic mandates, especially when applied to organ donor candidates. Most clinicians rely on published guidelines. However, surveys of academic institutions in the United States have found that there is considerable variability in adherence to published guidelines and clinical practice. Variable documentation of brain death criteria was also observed in a series of 142 children referred for organ donation, and in a chart review of 226 organ donors collected from 68 hospitals in the Midwest United States. […] In most adult series, trauma and subarachnoid hemorrhage are the most common events leading to brain death. Others include intracerebral hemorrhage, hypoxic-ischemic encephalopathy, and ischemic stroke. Any condition causing permanent widespread brain injury can lead to brain death.

• #4 Diagnosis of brain death – UpToDate

  https://www.uptodate.com/contents/diagnosis-of-brain-death

  Brain death signifies the complete, irreversible cessation of brain function, including the capacity for the brainstem to regulate respiratory and vegetative activities. It was first described in 1959, predating widespread organ donation, which has since made its codification critically necessary. While most countries have a legal provision for brain death, institutional protocols for diagnosis are not universal and are often absent, particularly in lower-income countries and in those without an organized transplant network. Even among countries with an organized diagnostic protocol, there is substantial variation in the criteria that are used. […] While United States law equates brain death with cardiopulmonary death, specific criteria for diagnosis are not mandated. Some states and institutions have specific diagnostic mandates, especially when applied to organ donor candidates. Most clinicians rely on published guidelines. However, surveys of academic institutions in the United States have found that there is considerable variability in adherence to published guidelines and clinical practice. Variable documentation of brain death criteria was also observed in a series of 142 children referred for organ donation, and in a chart review of 226 organ donors collected from 68 hospitals in the Midwest United States. […] In most adult series, trauma and subarachnoid hemorrhage are the most common events leading to brain death. Others include intracerebral hemorrhage, hypoxic-ischemic encephalopathy, and ischemic stroke. Any condition causing permanent widespread brain injury can lead to brain death.

• #5 Brain death: a clinical overview | Journal of Intensive Care | Full Text

  https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-022-00609-4

  Brain death, also commonly referred to as death by neurologic criteria, has been considered a legal definition of death for decades. […] In 1980, the Uniform Determination of Death Act established a legal basis for a neurologic determination of death in the U.S., and adult guidelines were put forth in the 1995 (and revised 2010) American Academy of Neurology (AAN) guidelines on the determination of BD/DNC. […] In practice, diagnosis of BD/DNC is essential to organ transplantation, particularly cardiac, in that brain dead donors are the only accepted source for cardiac transplant in the United States. […] The first and most widely accepted is the whole brain formulation which asserts that brain death is equivalent to catastrophic injury to all the major structures of the brain including the hemispheres, diencephalon, brainstem, and cerebellum.

• #6 Brain Death – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK538159/

  The most common processes leading to brain death, in order of frequency, are cardiopulmonary arrest, TBI, subarachnoid hemorrhage, and intracerebral hemorrhage. Among extracranial causes, patients who experience cardiopulmonary arrest show a progression to brain death in 8.9% of cases post-resuscitation. For those presenting with TBI, the rate of progression to brain death ranges from 2.8% to 6.1%. Regarding intracranial etiologies, patients with a subarachnoid hemorrhage progress to brain death in 8.5% to 10.7% of cases, while those with intracerebral hemorrhage progress at a rate of 6.1% to 9.6%. Notably, by definition, brain death is associated with a 100% mortality rate. […] In 2012, the World Health Organization (WHO) partnered with an international forum to endorse brain death as the official diagnosis of death. However, internationally and even within different states of the United States, there is no uniformity to certify brain death. Brain death criteria also differ based on the patient’s age. Therefore, different standards are in effect when performing a document of brain death, and the provider should be aware of their country/state’s criteria for a specific patient’s age.

• #7 Brain death: a clinical overview | Journal of Intensive Care | Full Text

  https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-022-00609-4

  Brain death, also commonly referred to as death by neurologic criteria, has been considered a legal definition of death for decades. […] In 1980, the Uniform Determination of Death Act established a legal basis for a neurologic determination of death in the U.S., and adult guidelines were put forth in the 1995 (and revised 2010) American Academy of Neurology (AAN) guidelines on the determination of BD/DNC. […] In practice, diagnosis of BD/DNC is essential to organ transplantation, particularly cardiac, in that brain dead donors are the only accepted source for cardiac transplant in the United States. […] The first and most widely accepted is the whole brain formulation which asserts that brain death is equivalent to catastrophic injury to all the major structures of the brain including the hemispheres, diencephalon, brainstem, and cerebellum.

• #8 Brain death: a clinical overview | Journal of Intensive Care | Full Text

  https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-022-00609-4

  The second concept refers to brainstem death which is the accepted construct in the United Kingdom (U.K.) and a few other countries, asserting that destruction of the brainstem alone is equivalent to the death of a human, given that the brainstem partially houses the centers for consciousness, as well as essential cardiac and respiratory centers. […] In general, the BD/DNC evaluation is performed similarly in an ECMO patient. […] The basic concept of apnea testing remains the same: pre-oxygenation, observation for spontaneous breaths, and measurements proving the buildup of CO2 in arterial circulation. […] The indications for ancillary testing in ECMO patients, and interpretation of different types of testing, are not well studied, and particular caution should be taken with use of TCD, as it relies on measurement of pulsatile flow.

• #9 Incidence of brain death in the United States – PubMed

  https://pubmed.ncbi.nlm.nih.gov/32442805/

  Objectives: The epidemiological analysis of brain death (BD) can assist physicians in their development of relevant guidelines regarding training and action protocols. This study aims to find the incidence of BD in the United States. […] In recent years, the incidence of BD has increased in the United States. Knowing the incidence of BD and the establishment of long-term programs that raise awareness about BD may increase the number of potential organ donors in the future.

• #10 Brain death – Wikipedia

  https://en.wikipedia.org/wiki/Brain_death

  Brain death is responsible for 2% of all adult and 5% of pediatric in-hospital deaths in the United States. […] In a nationwide survey of pediatric intensive care units (PICU) in the United States in 2019; there were more than 3,000 pediatric brain deaths out of a total of more than 15,344 children who died in PICUs. According to a national study, „brain death evaluations are performed infrequently, even in large PICUs.”

• #11 Diagnosis: Brain & Circulatory Death in Organ Donation | Donor Alliance

  https://www.donoralliance.org/diagnosis/

  There are numerous laws, regulations and standards that govern how and when a medical professional can make an official declaration of death. What is most important to know is that hospitals and emergency medical professionals will make every effort to save a patient’s life regardless of their status as a donor. […] Death can occur in one of two ways: cardiac death, when the heart is no longer able to beat on its own, and brain death, which is the irreversible loss of function of the brain, including the brain stem. […] According to the Uniform Determination of Death Act, brain death is defined as the irreversible cessation of all functions of the entire brain, including the brain stem. A brain-dead person is dead, although his or her cardiopulmonary functioning may be artificially maintained for some time. […] Brain death determination is rare and occurs only in about 1 out of every 100 hospital deaths.

• #12 Brain death – Wikipedia

  https://en.wikipedia.org/wiki/Brain_death

  Brain death is responsible for 2% of all adult and 5% of pediatric in-hospital deaths in the United States. […] In a nationwide survey of pediatric intensive care units (PICU) in the United States in 2019; there were more than 3,000 pediatric brain deaths out of a total of more than 15,344 children who died in PICUs. According to a national study, „brain death evaluations are performed infrequently, even in large PICUs.”

• #13 Quick Take: Epidemiology of brain death in pediatric intensive care units in the United States | 2 Minute Medicine

  https://www.2minutemedicine.com/quick-take-epidemiology-of-brain-death-in-pediatric-intensive-care-units-in-the-united-states/

  Quick Take: Epidemiology of brain death in pediatric intensive care units in the United States […] In the United States, brain death is exclusively diagnosed in critical care settings, owing to the need for mechanical ventilatory support. […] In this national database study of 15,344 patients who died in pediatric intensive care units (PICUs), data on patient deaths were abstracted to characterize the epidemiology and clinical characteristics of pediatric patients declared brain dead in the US (2012-2017). Researchers found that of those patients who had died, 20.7% had been declared brain dead. […] This study therefore showed that brain death occurred in at least 20% of PICU deaths, with most resulting from acute hypoxic-ischemic or traumatic brain injury. […] Physician education, standardization of brain death protocols, and the use of precise, consistent language are important to ensure the integrity of brain death determination.

• #14 Brain death – Wikipedia

  https://en.wikipedia.org/wiki/Brain_death

  Brain death is responsible for 2% of all adult and 5% of pediatric in-hospital deaths in the United States. […] In a nationwide survey of pediatric intensive care units (PICU) in the United States in 2019; there were more than 3,000 pediatric brain deaths out of a total of more than 15,344 children who died in PICUs. According to a national study, „brain death evaluations are performed infrequently, even in large PICUs.”

• #15 Epidemiology of brain death in pediatric intensive care units in the Un

  https://beta.m3india.in/contents/journal/epidemiology-of-brain-death-in-pediatric

  Epidemiology of brain death in pediatric intensive care units in the United States […] Researchers assessed pediatric patients declared brain dead in the US for their epidemiology and clinical features. […] They analyzed patient demographics, pre-illness developmental status, severity of illness, cause of death, pediatric intensive care unit (PICU) medical and physical length of stay, and organ donation status. […] Findings revealed the occurrence of brain death in one-fifth of PICU deaths; no preexisting neurological dysfunction was detected in most of these children, and the majority had acute hypoxic-ischemic or traumatic brain injury. […] Even in large PICUs, infrequent brain death determinations were reported.

• #16 Quick Take: Epidemiology of brain death in pediatric intensive care units in the United States | 2 Minute Medicine

  https://www.2minutemedicine.com/quick-take-epidemiology-of-brain-death-in-pediatric-intensive-care-units-in-the-united-states/

  Quick Take: Epidemiology of brain death in pediatric intensive care units in the United States […] In the United States, brain death is exclusively diagnosed in critical care settings, owing to the need for mechanical ventilatory support. […] In this national database study of 15,344 patients who died in pediatric intensive care units (PICUs), data on patient deaths were abstracted to characterize the epidemiology and clinical characteristics of pediatric patients declared brain dead in the US (2012-2017). Researchers found that of those patients who had died, 20.7% had been declared brain dead. […] This study therefore showed that brain death occurred in at least 20% of PICU deaths, with most resulting from acute hypoxic-ischemic or traumatic brain injury. […] Physician education, standardization of brain death protocols, and the use of precise, consistent language are important to ensure the integrity of brain death determination.

• #17

  https://archivosdeneurociencias.org/index.php/ADN/article/view/46

  The death determined by neurological criteria or brain death (BD) is best understood as a brain failure or end of a complete and irreversible neurological failure clinical expression. […] Objective: to determine the causes of ME in the Intensive Care Unit of the National Institute of Neurology and Neurosurgery in Mexico. […] Results: 61% of the cases occurred in women. The mean age of the sample was 43.30 years (range 17-71 years). The most common cause of subarachnoid hemorrhage was ME, representing 55.93% of cases. […] Conclusion: an increase in the level of alert to the symptoms and signs that should guide the diagnosis of subarachnoid hemorrhage is required because it is an entity for which it is possible to offer treatment to avoid death.

• #18

  https://link.springer.com/article/10.1007/s00134-016-4549-3

  The occurrence of brain death in patients with hypoxic-ischaemic brain injury after resuscitation from cardiac arrest creates opportunities for organ donation. However, its prevalence is currently unknown. […] The overall prevalence of brain death among patients who died before hospital discharge was 12.6 [10.215.2] %. […] In patients with hypoxic-ischaemic brain injury following CPR, more than 10 % of deaths were due to brain death. More than 40 % of brain-dead patients could donate organs. […] The prevalence of brain death was significantly higher in patients resuscitated with e-CPR than in patients resuscitated with c-CPR, both as a percentage of total deaths (27.9 [19.736.6] vs. 8.3 [6.510.4] %) and as a percentage of total patients (21.9 [16.627.5] vs. 5.4 [3.97.1] %; p 0.0001 for both).

• #19 Brain Death – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK538159/

  The most common processes leading to brain death, in order of frequency, are cardiopulmonary arrest, TBI, subarachnoid hemorrhage, and intracerebral hemorrhage. Among extracranial causes, patients who experience cardiopulmonary arrest show a progression to brain death in 8.9% of cases post-resuscitation. For those presenting with TBI, the rate of progression to brain death ranges from 2.8% to 6.1%. Regarding intracranial etiologies, patients with a subarachnoid hemorrhage progress to brain death in 8.5% to 10.7% of cases, while those with intracerebral hemorrhage progress at a rate of 6.1% to 9.6%. Notably, by definition, brain death is associated with a 100% mortality rate. […] In 2012, the World Health Organization (WHO) partnered with an international forum to endorse brain death as the official diagnosis of death. However, internationally and even within different states of the United States, there is no uniformity to certify brain death. Brain death criteria also differ based on the patient’s age. Therefore, different standards are in effect when performing a document of brain death, and the provider should be aware of their country/state’s criteria for a specific patient’s age.

• #20 Criteria Of Brain Death – Neuropedia

  https://neuropedia.net/articles/neuroscience/criteria-of-brain-death/

  Brain death is diagnosed following catastrophic brain injuries such as trauma, intracranial hemorrhage, or hypoxic brain injury while the circulation is present, and ventilation is provided mechanically, hypoxic brain injury following increasingly successful cardiopulmonary resuscitation (CPR) after cardiac arrest is recognized as one of the most common etiologies of brain death, so brain death can be caused by various conditions or events that result in severe brain injury or damage such as brain tumors, stroke and anoxic brain injury. […] The most common processes leading to brain death in order of frequency, are cardiopulmonary arrest, traumatic brain injury (TBI), subarachnoid hemorrhage, and intracerebral hemorrhage. Among extracranial causes, patient who experiences cardiopulmonary arrest shows a progression to brain death in 8.9% of cases post-resuscitation. For those presenting with TBI, the rate of progression to brain death ranges from 2.8% to 6.1%. Regarding intracranial etiologies, patients with a subarachnoid hemorrhage proceed to brain death in 8.5% to 10.7% of cases, while those with intracerebral hemorrhage progress at a rate of 6.1% to 9.6%. Notably, brain death is associated with a 100% mortality rate.

• #21 Brain Death – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK538159/

  The most common processes leading to brain death, in order of frequency, are cardiopulmonary arrest, TBI, subarachnoid hemorrhage, and intracerebral hemorrhage. Among extracranial causes, patients who experience cardiopulmonary arrest show a progression to brain death in 8.9% of cases post-resuscitation. For those presenting with TBI, the rate of progression to brain death ranges from 2.8% to 6.1%. Regarding intracranial etiologies, patients with a subarachnoid hemorrhage progress to brain death in 8.5% to 10.7% of cases, while those with intracerebral hemorrhage progress at a rate of 6.1% to 9.6%. Notably, by definition, brain death is associated with a 100% mortality rate. […] In 2012, the World Health Organization (WHO) partnered with an international forum to endorse brain death as the official diagnosis of death. However, internationally and even within different states of the United States, there is no uniformity to certify brain death. Brain death criteria also differ based on the patient’s age. Therefore, different standards are in effect when performing a document of brain death, and the provider should be aware of their country/state’s criteria for a specific patient’s age.

• #22 Criteria Of Brain Death – Neuropedia

  https://neuropedia.net/articles/neuroscience/criteria-of-brain-death/

  Brain death is diagnosed following catastrophic brain injuries such as trauma, intracranial hemorrhage, or hypoxic brain injury while the circulation is present, and ventilation is provided mechanically, hypoxic brain injury following increasingly successful cardiopulmonary resuscitation (CPR) after cardiac arrest is recognized as one of the most common etiologies of brain death, so brain death can be caused by various conditions or events that result in severe brain injury or damage such as brain tumors, stroke and anoxic brain injury. […] The most common processes leading to brain death in order of frequency, are cardiopulmonary arrest, traumatic brain injury (TBI), subarachnoid hemorrhage, and intracerebral hemorrhage. Among extracranial causes, patient who experiences cardiopulmonary arrest shows a progression to brain death in 8.9% of cases post-resuscitation. For those presenting with TBI, the rate of progression to brain death ranges from 2.8% to 6.1%. Regarding intracranial etiologies, patients with a subarachnoid hemorrhage proceed to brain death in 8.5% to 10.7% of cases, while those with intracerebral hemorrhage progress at a rate of 6.1% to 9.6%. Notably, brain death is associated with a 100% mortality rate.

• #23 Diagnosis of brain death – UpToDate

  https://www.uptodate.com/contents/diagnosis-of-brain-death

  Brain death signifies the complete, irreversible cessation of brain function, including the capacity for the brainstem to regulate respiratory and vegetative activities. It was first described in 1959, predating widespread organ donation, which has since made its codification critically necessary. While most countries have a legal provision for brain death, institutional protocols for diagnosis are not universal and are often absent, particularly in lower-income countries and in those without an organized transplant network. Even among countries with an organized diagnostic protocol, there is substantial variation in the criteria that are used. […] While United States law equates brain death with cardiopulmonary death, specific criteria for diagnosis are not mandated. Some states and institutions have specific diagnostic mandates, especially when applied to organ donor candidates. Most clinicians rely on published guidelines. However, surveys of academic institutions in the United States have found that there is considerable variability in adherence to published guidelines and clinical practice. Variable documentation of brain death criteria was also observed in a series of 142 children referred for organ donation, and in a chart review of 226 organ donors collected from 68 hospitals in the Midwest United States. […] In most adult series, trauma and subarachnoid hemorrhage are the most common events leading to brain death. Others include intracerebral hemorrhage, hypoxic-ischemic encephalopathy, and ischemic stroke. Any condition causing permanent widespread brain injury can lead to brain death.

• #24 LearnPICU – Brain Death

  https://www.learnpicu.com/neurology/brain-death

  The determination of brain death is made by a physician based on accepted medical standards. […] The cause of the condition should be established if at all possible. Brain death determination should not be made in the presence of potentially reversible conditions and conditions such as cardiovascular SHOCK, DRUG INTOXICATION, or HYPOTHERMIA, in which brain death cannot be determined reliably. […] The diagnosis of brain death is BASED UPON CLINICAL CRITERIA. […] The absence of spontaneous respiration, in the presence of hypercarbia (paCO2 greater than 60 mm Hg AND at least 20 mm Hg above the baseline paCO2) should be observed by a physician and carefully documented. […] The determination of brain death may be made on the basis of clinical observations alone (over the appropriate time interval-see below).

• #25 LearnPICU – Brain Death

  https://www.learnpicu.com/neurology/brain-death

  The determination of brain death is made by a physician based on accepted medical standards. […] The cause of the condition should be established if at all possible. Brain death determination should not be made in the presence of potentially reversible conditions and conditions such as cardiovascular SHOCK, DRUG INTOXICATION, or HYPOTHERMIA, in which brain death cannot be determined reliably. […] The diagnosis of brain death is BASED UPON CLINICAL CRITERIA. […] The absence of spontaneous respiration, in the presence of hypercarbia (paCO2 greater than 60 mm Hg AND at least 20 mm Hg above the baseline paCO2) should be observed by a physician and carefully documented. […] The determination of brain death may be made on the basis of clinical observations alone (over the appropriate time interval-see below).

• #26 Role of Clinical and Multimodality Neuroimaging in the Evaluation of Brain Death/Death by Neurologic Criteria and Recent Highlights from 2023 Updated Guidelines

  https://www.mdpi.com/2075-4418/14/12/1287

  Brain death/death by neurologic criteria (BD/DNC) is a permanent cessation of brain function, including brainstem reflexes and circulatory and respiratory functions. Furthermore, 2.06% of deaths in the United States are accounted for by this diagnosis. The American Academy of Neurology (AAN) has provided guidelines for the clinical criteria for the diagnosis of BD/DNC. These guidelines were recently updated in October of 2023 and now incorporate both pediatric and adult patients. The new AAN guidelines provide prerequisites regarding the appropriate determination of this declaration and now include both pediatric (>37 weeks corrected gestational age) and adult patients. The assessment for BD/DNC necessitates a comprehensive evaluation encompassing unresponsiveness to visual, auditory, and tactile stimuli, as well as the absence of motor responses in facial features and extremities, excluding spinal reflexes. Ancillary testing is required to support the diagnosis of BD/DNC when neurological examinations and apnea testing cannot be completed, the findings are indeterminate, or the patient has persistent metabolic derangements on laboratory studies despite findings which are consistent with BD/DNC per the current AAN recommendations. Most of the United States legally allows appropriately licensed physicians to determine BD/DNC; however, updates to examiner qualifications have been made, and trainees may be supervised as needed in settings where they are not permitted to examine these patients independently. The catheter cerebral angiogram, nuclear scintigraphy, and transcranial Doppler are recommended ancillary tests for the diagnosis of BD/DNC by the AAN. Most of the United States and many countries worldwide use the AAN clinical criteria for BD/DNC diagnosis, though variability persists in the preclinical testing, clinical examination, ancillary tests, and apnea tests.

• #27 Devastating Brain Injuries: Assessment and Management Part I: Overview of Brain Death – The Western Journal of Emergency Medicine

  https://westjem.com/articles/devastating-brain-injuries-assessment-and-management-part-i-overview-of-brain-death.html

  The concept of brain death has caused great controversy in medicine and politics. It is debated by ethicists, law professors, government agencies and healthcare workers.811First introduced by Mollaret and Goulon in 1959, brain death was originally described as a persistent vegetative state or permanent coma.12 After 1959, the definition evolved until 1968 when a Harvard Medical School ad hoc committee created the current definition, which was later affirmed by the Uniform Determination of Death Act in 1981.12,13 […] To establish a diagnosis of brain death, the clinician must first identify the underlying causes and determine that they are irreversible.12 Trauma, stroke, cerebral hypoxia, intracranial hemorrhage, tumors, meningitis, and encephalitis are all well-known causes.15 All confounding factors must be eliminated, such as hypothermia ( 35C), hypoxia, intoxication by legal or illegal drugs, shock/hypotension, and severe electrolyte disturbances.12

• #28 Devastating Brain Injuries: Assessment and Management Part I: Overview of Brain Death – The Western Journal of Emergency Medicine

  https://westjem.com/articles/devastating-brain-injuries-assessment-and-management-part-i-overview-of-brain-death.html

  The concept of brain death has caused great controversy in medicine and politics. It is debated by ethicists, law professors, government agencies and healthcare workers.811First introduced by Mollaret and Goulon in 1959, brain death was originally described as a persistent vegetative state or permanent coma.12 After 1959, the definition evolved until 1968 when a Harvard Medical School ad hoc committee created the current definition, which was later affirmed by the Uniform Determination of Death Act in 1981.12,13 […] To establish a diagnosis of brain death, the clinician must first identify the underlying causes and determine that they are irreversible.12 Trauma, stroke, cerebral hypoxia, intracranial hemorrhage, tumors, meningitis, and encephalitis are all well-known causes.15 All confounding factors must be eliminated, such as hypothermia ( 35C), hypoxia, intoxication by legal or illegal drugs, shock/hypotension, and severe electrolyte disturbances.12

• #29 Devastating Brain Injuries: Assessment and Management Part I: Overview of Brain Death – The Western Journal of Emergency Medicine

  https://westjem.com/articles/devastating-brain-injuries-assessment-and-management-part-i-overview-of-brain-death.html

  The concept of brain death has caused great controversy in medicine and politics. It is debated by ethicists, law professors, government agencies and healthcare workers.811First introduced by Mollaret and Goulon in 1959, brain death was originally described as a persistent vegetative state or permanent coma.12 After 1959, the definition evolved until 1968 when a Harvard Medical School ad hoc committee created the current definition, which was later affirmed by the Uniform Determination of Death Act in 1981.12,13 […] To establish a diagnosis of brain death, the clinician must first identify the underlying causes and determine that they are irreversible.12 Trauma, stroke, cerebral hypoxia, intracranial hemorrhage, tumors, meningitis, and encephalitis are all well-known causes.15 All confounding factors must be eliminated, such as hypothermia ( 35C), hypoxia, intoxication by legal or illegal drugs, shock/hypotension, and severe electrolyte disturbances.12

• #30 Devastating Brain Injuries: Assessment and Management Part I: Overview of Brain Death – The Western Journal of Emergency Medicine

  https://westjem.com/articles/devastating-brain-injuries-assessment-and-management-part-i-overview-of-brain-death.html

  The concept of brain death has caused great controversy in medicine and politics. It is debated by ethicists, law professors, government agencies and healthcare workers.811First introduced by Mollaret and Goulon in 1959, brain death was originally described as a persistent vegetative state or permanent coma.12 After 1959, the definition evolved until 1968 when a Harvard Medical School ad hoc committee created the current definition, which was later affirmed by the Uniform Determination of Death Act in 1981.12,13 […] To establish a diagnosis of brain death, the clinician must first identify the underlying causes and determine that they are irreversible.12 Trauma, stroke, cerebral hypoxia, intracranial hemorrhage, tumors, meningitis, and encephalitis are all well-known causes.15 All confounding factors must be eliminated, such as hypothermia ( 35C), hypoxia, intoxication by legal or illegal drugs, shock/hypotension, and severe electrolyte disturbances.12

• #31 LearnPICU – Brain Death

  https://www.learnpicu.com/neurology/brain-death

  The determination of brain death is made by a physician based on accepted medical standards. […] The cause of the condition should be established if at all possible. Brain death determination should not be made in the presence of potentially reversible conditions and conditions such as cardiovascular SHOCK, DRUG INTOXICATION, or HYPOTHERMIA, in which brain death cannot be determined reliably. […] The diagnosis of brain death is BASED UPON CLINICAL CRITERIA. […] The absence of spontaneous respiration, in the presence of hypercarbia (paCO2 greater than 60 mm Hg AND at least 20 mm Hg above the baseline paCO2) should be observed by a physician and carefully documented. […] The determination of brain death may be made on the basis of clinical observations alone (over the appropriate time interval-see below).

• #32 Brain death: a clinical overview | Journal of Intensive Care | Full Text

  https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-022-00609-4

  The second concept refers to brainstem death which is the accepted construct in the United Kingdom (U.K.) and a few other countries, asserting that destruction of the brainstem alone is equivalent to the death of a human, given that the brainstem partially houses the centers for consciousness, as well as essential cardiac and respiratory centers. […] In general, the BD/DNC evaluation is performed similarly in an ECMO patient. […] The basic concept of apnea testing remains the same: pre-oxygenation, observation for spontaneous breaths, and measurements proving the buildup of CO2 in arterial circulation. […] The indications for ancillary testing in ECMO patients, and interpretation of different types of testing, are not well studied, and particular caution should be taken with use of TCD, as it relies on measurement of pulsatile flow.

• #33

  https://www.iowadonornetwork.org/professional-partners/hospital-professionals/organ-donation-process/brain-death-ddnc

  In 2010, the American Academy of Neurology updated guidelines for determining brain death in adults. […] An apnea test is considered positive if the PCO2 is 60 mmHg or rises 20 mmHg normal baseline value. […] In instances in which a component of the neurological examination or apnea test cannot be completed, ancillary testing can be used to confirm brain death. […] In pediatrics, it is recommended that two physicians must perform independent examinations separated by specified time intervals. […] Time intervals between tests should be at least 24 hours unless an ancillary study is performed and is consistent with brain death. […] Time intervals between tests should be at least 12 hours unless an ancillary study is performed and is consistent with brain death.

• #34

  https://www.iowadonornetwork.org/professional-partners/hospital-professionals/organ-donation-process/brain-death-ddnc

  In 2010, the American Academy of Neurology updated guidelines for determining brain death in adults. […] An apnea test is considered positive if the PCO2 is 60 mmHg or rises 20 mmHg normal baseline value. […] In instances in which a component of the neurological examination or apnea test cannot be completed, ancillary testing can be used to confirm brain death. […] In pediatrics, it is recommended that two physicians must perform independent examinations separated by specified time intervals. […] Time intervals between tests should be at least 24 hours unless an ancillary study is performed and is consistent with brain death. […] Time intervals between tests should be at least 12 hours unless an ancillary study is performed and is consistent with brain death.

• #35 Brain Death – EMCrit Project

  https://emcrit.org/ibcc/brain-death/

  The most useful confirmatory test is cerebral scintigraphy: Radiolabeled dye is injected into a peripheral vein. If there is perfusion to the brain, the dye will be taken up in brain tissue. […] In brain death, lack of brain perfusion causes an empty skull sign. […] Time of death is either: (1) The time of the apnea test. (2) The time that the ancillary study is documented. […] Ongoing high-quality supportive care is required to maximize organ function. […] Optimal management of the donor may increase the likelihood of successful allograft function and favorable long-term outcomes for organ recipients.

• #36 Brain Death – EMCrit Project

  https://emcrit.org/ibcc/brain-death/

  The most useful confirmatory test is cerebral scintigraphy: Radiolabeled dye is injected into a peripheral vein. If there is perfusion to the brain, the dye will be taken up in brain tissue. […] In brain death, lack of brain perfusion causes an empty skull sign. […] Time of death is either: (1) The time of the apnea test. (2) The time that the ancillary study is documented. […] Ongoing high-quality supportive care is required to maximize organ function. […] Optimal management of the donor may increase the likelihood of successful allograft function and favorable long-term outcomes for organ recipients.

• #37 Role of Clinical and Multimodality Neuroimaging in the Evaluation of Brain Death/Death by Neurologic Criteria and Recent Highlights from 2023 Updated Guidelines

  https://www.mdpi.com/2075-4418/14/12/1287

  Brain death/death by neurologic criteria (BD/DNC) is a permanent cessation of brain function, including brainstem reflexes and circulatory and respiratory functions. Furthermore, 2.06% of deaths in the United States are accounted for by this diagnosis. The American Academy of Neurology (AAN) has provided guidelines for the clinical criteria for the diagnosis of BD/DNC. These guidelines were recently updated in October of 2023 and now incorporate both pediatric and adult patients. The new AAN guidelines provide prerequisites regarding the appropriate determination of this declaration and now include both pediatric (>37 weeks corrected gestational age) and adult patients. The assessment for BD/DNC necessitates a comprehensive evaluation encompassing unresponsiveness to visual, auditory, and tactile stimuli, as well as the absence of motor responses in facial features and extremities, excluding spinal reflexes. Ancillary testing is required to support the diagnosis of BD/DNC when neurological examinations and apnea testing cannot be completed, the findings are indeterminate, or the patient has persistent metabolic derangements on laboratory studies despite findings which are consistent with BD/DNC per the current AAN recommendations. Most of the United States legally allows appropriately licensed physicians to determine BD/DNC; however, updates to examiner qualifications have been made, and trainees may be supervised as needed in settings where they are not permitted to examine these patients independently. The catheter cerebral angiogram, nuclear scintigraphy, and transcranial Doppler are recommended ancillary tests for the diagnosis of BD/DNC by the AAN. Most of the United States and many countries worldwide use the AAN clinical criteria for BD/DNC diagnosis, though variability persists in the preclinical testing, clinical examination, ancillary tests, and apnea tests.

• #38 Current controversies in brain death determination | Nature Reviews Neurology

  https://www.nature.com/articles/nrneurol.2017.72

  Although the concept of brain death is accepted by the majority of physicians, lawyers, ethicists and society at large, controversies about determination of death by neurological criteria persist, and often reach the public eye. […] We review current controversies, including protocol variability, recognition of the American Academy of Neurology (AAN) criteria for brain death as an accepted medical standard, and management of objections to discontinuation of organ support after determination of brain death. […] We argue that medical societies and governmental regulatory bodies must support the AAN criteria in order to decrease protocol variability, and must fully endorse the validity of these criteria as accepted medical standards.

• #39 Diagnosis of brain death – UpToDate

  https://www.uptodate.com/contents/diagnosis-of-brain-death

  Brain death signifies the complete, irreversible cessation of brain function, including the capacity for the brainstem to regulate respiratory and vegetative activities. It was first described in 1959, predating widespread organ donation, which has since made its codification critically necessary. While most countries have a legal provision for brain death, institutional protocols for diagnosis are not universal and are often absent, particularly in lower-income countries and in those without an organized transplant network. Even among countries with an organized diagnostic protocol, there is substantial variation in the criteria that are used. […] While United States law equates brain death with cardiopulmonary death, specific criteria for diagnosis are not mandated. Some states and institutions have specific diagnostic mandates, especially when applied to organ donor candidates. Most clinicians rely on published guidelines. However, surveys of academic institutions in the United States have found that there is considerable variability in adherence to published guidelines and clinical practice. Variable documentation of brain death criteria was also observed in a series of 142 children referred for organ donation, and in a chart review of 226 organ donors collected from 68 hospitals in the Midwest United States. […] In most adult series, trauma and subarachnoid hemorrhage are the most common events leading to brain death. Others include intracerebral hemorrhage, hypoxic-ischemic encephalopathy, and ischemic stroke. Any condition causing permanent widespread brain injury can lead to brain death.

• #40 Diagnosis of brain death – UpToDate

  https://www.uptodate.com/contents/diagnosis-of-brain-death

  Brain death signifies the complete, irreversible cessation of brain function, including the capacity for the brainstem to regulate respiratory and vegetative activities. It was first described in 1959, predating widespread organ donation, which has since made its codification critically necessary. While most countries have a legal provision for brain death, institutional protocols for diagnosis are not universal and are often absent, particularly in lower-income countries and in those without an organized transplant network. Even among countries with an organized diagnostic protocol, there is substantial variation in the criteria that are used. […] While United States law equates brain death with cardiopulmonary death, specific criteria for diagnosis are not mandated. Some states and institutions have specific diagnostic mandates, especially when applied to organ donor candidates. Most clinicians rely on published guidelines. However, surveys of academic institutions in the United States have found that there is considerable variability in adherence to published guidelines and clinical practice. Variable documentation of brain death criteria was also observed in a series of 142 children referred for organ donation, and in a chart review of 226 organ donors collected from 68 hospitals in the Midwest United States. […] In most adult series, trauma and subarachnoid hemorrhage are the most common events leading to brain death. Others include intracerebral hemorrhage, hypoxic-ischemic encephalopathy, and ischemic stroke. Any condition causing permanent widespread brain injury can lead to brain death.

• #41 Diagnosis of brain death – UpToDate

  https://www.uptodate.com/contents/diagnosis-of-brain-death

  Brain death signifies the complete, irreversible cessation of brain function, including the capacity for the brainstem to regulate respiratory and vegetative activities. It was first described in 1959, predating widespread organ donation, which has since made its codification critically necessary. While most countries have a legal provision for brain death, institutional protocols for diagnosis are not universal and are often absent, particularly in lower-income countries and in those without an organized transplant network. Even among countries with an organized diagnostic protocol, there is substantial variation in the criteria that are used. […] While United States law equates brain death with cardiopulmonary death, specific criteria for diagnosis are not mandated. Some states and institutions have specific diagnostic mandates, especially when applied to organ donor candidates. Most clinicians rely on published guidelines. However, surveys of academic institutions in the United States have found that there is considerable variability in adherence to published guidelines and clinical practice. Variable documentation of brain death criteria was also observed in a series of 142 children referred for organ donation, and in a chart review of 226 organ donors collected from 68 hospitals in the Midwest United States. […] In most adult series, trauma and subarachnoid hemorrhage are the most common events leading to brain death. Others include intracerebral hemorrhage, hypoxic-ischemic encephalopathy, and ischemic stroke. Any condition causing permanent widespread brain injury can lead to brain death.

• #42 Determining Brain Death: No Room for Error | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/determining-brain-death-no-room-error/2010-11

  Brain death is a uniquely modern, largely hospital-based phenomenon. […] In fact, recent data show that BD policies are still remarkably heterogeneous, even amongst some of the nations most vaunted medical institutions. […] We argue that urgent attention must be given to consistent application and regular review of our adopted medical and legal standardsa position which we believe will serve to strengthen research and facilitate ongoing ethical debate surrounding BD. […] The most recent such study evaluated BD policies of the neurology and neurosurgery programs named by U.S. News and World Report as the top 50 in the U.S. […] Based on the reported variability in BD determination and the poor quality of empirical clinical evidence in support of current recommendations, some have voiced valid ethical concerns about the reliability, internal consistency, and even the necessity of the concept of BD.

• #43 Determining Brain Death: No Room for Error | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/determining-brain-death-no-room-error/2010-11

  Brain death is a uniquely modern, largely hospital-based phenomenon. […] In fact, recent data show that BD policies are still remarkably heterogeneous, even amongst some of the nations most vaunted medical institutions. […] We argue that urgent attention must be given to consistent application and regular review of our adopted medical and legal standardsa position which we believe will serve to strengthen research and facilitate ongoing ethical debate surrounding BD. […] The most recent such study evaluated BD policies of the neurology and neurosurgery programs named by U.S. News and World Report as the top 50 in the U.S. […] Based on the reported variability in BD determination and the poor quality of empirical clinical evidence in support of current recommendations, some have voiced valid ethical concerns about the reliability, internal consistency, and even the necessity of the concept of BD.

• #44 Determining Brain Death: No Room for Error | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/determining-brain-death-no-room-error/2010-11

  Nearly 30 years after the Uniform Determination of Death Act, and 15 years after the initial American Academy of Neurology guidelines, continued variability in the determination of BD from state to state, hospital to hospital, and, most likely, physician to physician undermines the validity of the concept in the minds of practitioners and the public alike. […] A national consensus panel representing expert opinion and knowledge of the published literature should meet regularly to review and revise national standards as necessary, given the ever-evolving state of medical science and technology. […] Standards and policies are only the first step, however. […] A standardized, rigorous approach to BD determination is something that we owe our patients and their familiesfor in such a diagnosis, there is no room for correcting mistakes.

• #45 Diagnosis of brain death – UpToDate

  https://www.uptodate.com/contents/diagnosis-of-brain-death

  Brain death signifies the complete, irreversible cessation of brain function, including the capacity for the brainstem to regulate respiratory and vegetative activities. It was first described in 1959, predating widespread organ donation, which has since made its codification critically necessary. While most countries have a legal provision for brain death, institutional protocols for diagnosis are not universal and are often absent, particularly in lower-income countries and in those without an organized transplant network. Even among countries with an organized diagnostic protocol, there is substantial variation in the criteria that are used. […] While United States law equates brain death with cardiopulmonary death, specific criteria for diagnosis are not mandated. Some states and institutions have specific diagnostic mandates, especially when applied to organ donor candidates. Most clinicians rely on published guidelines. However, surveys of academic institutions in the United States have found that there is considerable variability in adherence to published guidelines and clinical practice. Variable documentation of brain death criteria was also observed in a series of 142 children referred for organ donation, and in a chart review of 226 organ donors collected from 68 hospitals in the Midwest United States. […] In most adult series, trauma and subarachnoid hemorrhage are the most common events leading to brain death. Others include intracerebral hemorrhage, hypoxic-ischemic encephalopathy, and ischemic stroke. Any condition causing permanent widespread brain injury can lead to brain death.

• #46 Diagnosis of brain death – UpToDate

  https://www.uptodate.com/contents/diagnosis-of-brain-death

  Brain death signifies the complete, irreversible cessation of brain function, including the capacity for the brainstem to regulate respiratory and vegetative activities. It was first described in 1959, predating widespread organ donation, which has since made its codification critically necessary. While most countries have a legal provision for brain death, institutional protocols for diagnosis are not universal and are often absent, particularly in lower-income countries and in those without an organized transplant network. Even among countries with an organized diagnostic protocol, there is substantial variation in the criteria that are used. […] While United States law equates brain death with cardiopulmonary death, specific criteria for diagnosis are not mandated. Some states and institutions have specific diagnostic mandates, especially when applied to organ donor candidates. Most clinicians rely on published guidelines. However, surveys of academic institutions in the United States have found that there is considerable variability in adherence to published guidelines and clinical practice. Variable documentation of brain death criteria was also observed in a series of 142 children referred for organ donation, and in a chart review of 226 organ donors collected from 68 hospitals in the Midwest United States. […] In most adult series, trauma and subarachnoid hemorrhage are the most common events leading to brain death. Others include intracerebral hemorrhage, hypoxic-ischemic encephalopathy, and ischemic stroke. Any condition causing permanent widespread brain injury can lead to brain death.

• #47 Determining Brain Death: No Room for Error | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/determining-brain-death-no-room-error/2010-11

  Brain death is a uniquely modern, largely hospital-based phenomenon. […] In fact, recent data show that BD policies are still remarkably heterogeneous, even amongst some of the nations most vaunted medical institutions. […] We argue that urgent attention must be given to consistent application and regular review of our adopted medical and legal standardsa position which we believe will serve to strengthen research and facilitate ongoing ethical debate surrounding BD. […] The most recent such study evaluated BD policies of the neurology and neurosurgery programs named by U.S. News and World Report as the top 50 in the U.S. […] Based on the reported variability in BD determination and the poor quality of empirical clinical evidence in support of current recommendations, some have voiced valid ethical concerns about the reliability, internal consistency, and even the necessity of the concept of BD.

• #48 Brain death: a clinical overview | Journal of Intensive Care | Full Text

  https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-022-00609-4

  The minimum age to determine BD/DNC varies by country, ranging from 36 to 37 weeks gestation. […] It is imperative that determination of BD/DNC be standardized as much as possible throughout the world, including among institutions and among providers themselves in order to maintain public and professional confidence in brain death evaluations and ensure consistency.

• #49

  https://www.iowadonornetwork.org/professional-partners/hospital-professionals/organ-donation-process/brain-death-ddnc

  In 2010, the American Academy of Neurology updated guidelines for determining brain death in adults. […] An apnea test is considered positive if the PCO2 is 60 mmHg or rises 20 mmHg normal baseline value. […] In instances in which a component of the neurological examination or apnea test cannot be completed, ancillary testing can be used to confirm brain death. […] In pediatrics, it is recommended that two physicians must perform independent examinations separated by specified time intervals. […] Time intervals between tests should be at least 24 hours unless an ancillary study is performed and is consistent with brain death. […] Time intervals between tests should be at least 12 hours unless an ancillary study is performed and is consistent with brain death.

• #50 Brain death: a clinical overview | Journal of Intensive Care | Full Text

  https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-022-00609-4

  Brain death, also commonly referred to as death by neurologic criteria, has been considered a legal definition of death for decades. […] In 1980, the Uniform Determination of Death Act established a legal basis for a neurologic determination of death in the U.S., and adult guidelines were put forth in the 1995 (and revised 2010) American Academy of Neurology (AAN) guidelines on the determination of BD/DNC. […] In practice, diagnosis of BD/DNC is essential to organ transplantation, particularly cardiac, in that brain dead donors are the only accepted source for cardiac transplant in the United States. […] The first and most widely accepted is the whole brain formulation which asserts that brain death is equivalent to catastrophic injury to all the major structures of the brain including the hemispheres, diencephalon, brainstem, and cerebellum.

• #51 Brain death | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/brain-death

  Brain death occurs when a critically ill person dies sometime after being placed on life support. […] In some cases, a person who is brain dead may be a candidate for organ donation. […] Brain death is not the same as coma, because someone in a coma is unconscious but still alive. […] Brain death occurs when a critically ill patient dies sometime after being placed on life support. […] In some cases, a person who is brain dead may be a candidate for organ donation.

• #52 Evaluation of Patients Diagnosed with Brain Death in Paediatric Critical Care – The Journal of Pediatric Research

  https://jpedres.org/articles/evaluation-of-patients-diagnosed-with-brain-death-in-paediatric-critical-care/doi/jpr.galenos.2020.82474

  We aimed to investigate the rate of brain death (BD) determinations and organ donations in our tertiary pediatric intensive care unit (PICU), and to report the data on demographic pattern and supplementary descriptive data on the BD declarations. […] The incidence of BD in the pediatric intensive care unit (PICU) is between 16% and 20%. […] In our study, it is reported that BD was more frequent in patients with severe TBI in the PICU. […] Our observed BD rate seems to be similar to previous reports in the literature. […] Out of the 23 cases in our study, only 4 (17.4%) families agreed to organ donation. […] The organ donation rate was found to be 47% in 135 BD cases in a study from Canada which was based in four different PICU centers. […] We concluded that patients with severe TBI are the most likely candidates for BD declaration and are suitable for organ donation to those children in need. Early diagnosis and good donor care are of great importance, especially for pediatric patients waiting for organ transplants.

• #53 Evaluation of Patients Diagnosed with Brain Death in Paediatric Critical Care – The Journal of Pediatric Research

  https://jpedres.org/articles/evaluation-of-patients-diagnosed-with-brain-death-in-paediatric-critical-care/doi/jpr.galenos.2020.82474

  We aimed to investigate the rate of brain death (BD) determinations and organ donations in our tertiary pediatric intensive care unit (PICU), and to report the data on demographic pattern and supplementary descriptive data on the BD declarations. […] The incidence of BD in the pediatric intensive care unit (PICU) is between 16% and 20%. […] In our study, it is reported that BD was more frequent in patients with severe TBI in the PICU. […] Our observed BD rate seems to be similar to previous reports in the literature. […] Out of the 23 cases in our study, only 4 (17.4%) families agreed to organ donation. […] The organ donation rate was found to be 47% in 135 BD cases in a study from Canada which was based in four different PICU centers. […] We concluded that patients with severe TBI are the most likely candidates for BD declaration and are suitable for organ donation to those children in need. Early diagnosis and good donor care are of great importance, especially for pediatric patients waiting for organ transplants.

• #54 Controversy over the definition of brain death : Shots – Health News : NPR

  https://www.npr.org/sections/health-shots/2024/02/11/1228330149/brain-death-definition

  But eliminating brain death or requiring additional testing could significantly reduce the number of people who would be eligible for organ donation at a time when organs for transplantation remain in severely short supply. […] One of the reasons the commission paused rewriting the death act was concern that it would result in a hodgepodge of different laws, especially in the current highly polarized political environment and among debates over issues of life and death in the context of abortion. […] Pope, the bioethicist at Mitchell Hamline School of Law, would like to see a federal law or regulations that would create a uniform national standard.

• #55 What is the Difference Between a Coma and Brain Death? | LifeSource

  https://www.life-source.org/latest/what-is-the-difference-between-a-coma-and-brain-death/

  Families of a brain dead patient must, by federal regulations, be provided the option of organ donation. If the family declines donation, the mechanical ventilator, medications and fluids are discontinued, after which the heart stops. If the family says yes to donation, the regional organ procurement organization (LifeSource in MN, ND, SD) is involved. The donor’s body is kept functioning by artificial means, such as ventilated support until the recovery of organs and tissue for life-saving transplant.

• #56 Medical Management of Brain-Dead Organ Donors

  https://www.accjournal.org/journal/view.php?doi=10.4266/acc.2019.00430

  Medical Management of Brain-Dead Organ Donors A.S.M. Tanim Anwar, Jae-myeong Lee Acute and Critical Care 2019;34(1):14-29. DOI: https://doi.org/10.4266/acc.2019.00430 Published online: February 28, 2019 […] The first step in this process is identifying potential organ donors. Specifically, brain-dead patients require aggressive and intensive care from the declaration of brain death until organ retrieval. […] Currently, there are no specific protocols in place for this, and there are notable variations in the management strategies implemented across different transplant centers. […] A potential organ donor is defined by the presence of either brain death or a catastrophic and irreversible brain injury that leads to fulfilling the brain death criteria. […] Brain death is defined as the irreversible loss of all brain functions, including the brain stem.

• #57 Medical Management of Brain-Dead Organ Donors

  https://www.accjournal.org/journal/view.php?doi=10.4266/acc.2019.00430

  Medical Management of Brain-Dead Organ Donors A.S.M. Tanim Anwar, Jae-myeong Lee Acute and Critical Care 2019;34(1):14-29. DOI: https://doi.org/10.4266/acc.2019.00430 Published online: February 28, 2019 […] The first step in this process is identifying potential organ donors. Specifically, brain-dead patients require aggressive and intensive care from the declaration of brain death until organ retrieval. […] Currently, there are no specific protocols in place for this, and there are notable variations in the management strategies implemented across different transplant centers. […] A potential organ donor is defined by the presence of either brain death or a catastrophic and irreversible brain injury that leads to fulfilling the brain death criteria. […] Brain death is defined as the irreversible loss of all brain functions, including the brain stem.

• #58 Medical Management of Brain-Dead Organ Donors

  https://www.accjournal.org/journal/view.php?doi=10.4266/acc.2019.00430

  To diagnose and declare brain death, certain criteria need to be fulfilled, including irreversible coma, absence of brain stem reflexes, and no self-respiration. […] A brain-dead individual shows no clinical evidence of brain function upon physical examination, which includes no response to pain and no cranial nerve reflexes. […] Data shows that progression from brain death to somatic death results in the loss of 10% to 20% of potential donor tissues, therefore timely treatment of the donor is very crucial. […] Strict organ-protective intensive care of the potential organ donor is therefore the first step towards a successful transplant and in the treatment of the future organ recipient. […] The fundamental principles of organ donor management in intensive care units (ICU) are based on monitoring programs and therapies.

• #59 Medical Management of Brain-Dead Organ Donors

  https://www.accjournal.org/journal/view.php?doi=10.4266/acc.2019.00430

  To diagnose and declare brain death, certain criteria need to be fulfilled, including irreversible coma, absence of brain stem reflexes, and no self-respiration. […] A brain-dead individual shows no clinical evidence of brain function upon physical examination, which includes no response to pain and no cranial nerve reflexes. […] Data shows that progression from brain death to somatic death results in the loss of 10% to 20% of potential donor tissues, therefore timely treatment of the donor is very crucial. […] Strict organ-protective intensive care of the potential organ donor is therefore the first step towards a successful transplant and in the treatment of the future organ recipient. […] The fundamental principles of organ donor management in intensive care units (ICU) are based on monitoring programs and therapies.

• #60 Medical Management of Brain-Dead Organ Donors

  https://www.accjournal.org/journal/view.php?doi=10.4266/acc.2019.00430

  The medical management of the potential brain-dead organ donor is often dependent on the discretion of the primary critical care team with considerable variation in practices between ICUs. […] Given the variation in management protocols, donor goals were developed to establish a standard protocol aimed at maintaining the physiology close to normal values based on routine monitoring of ICU patients. […] The protocol we have proposed and provided in the checklist may help intensivists manage brain-dead organ donors to promote successful organ and tissue donations.

• #61 Medical Management of Brain-Dead Organ Donors

  https://www.accjournal.org/journal/view.php?doi=10.4266/acc.2019.00430

  The medical management of the potential brain-dead organ donor is often dependent on the discretion of the primary critical care team with considerable variation in practices between ICUs. […] Given the variation in management protocols, donor goals were developed to establish a standard protocol aimed at maintaining the physiology close to normal values based on routine monitoring of ICU patients. […] The protocol we have proposed and provided in the checklist may help intensivists manage brain-dead organ donors to promote successful organ and tissue donations.

• #62 Controversy over the definition of brain death : Shots – Health News : NPR

  https://www.npr.org/sections/health-shots/2024/02/11/1228330149/brain-death-definition

  The debate is focused on the Uniform Determination of Death Act, a law that was adopted by most states in the 1980s. The law says that death can be declared if someone has experienced „irreversible cessation of all functions of the entire brain.” […] Many experts say the discrepancy needs to be resolved to protect patients and their families, maintain public trust and reconcile what some see as a troubling disconnect between the law and medical practice. […] For years, doctors have declared brain death using a series of tests to determine four main criteria: whether a person has a profound and irreversible coma, has permanently lost the capacity to breathe, has permanently lost all reflexes controlled by the brainstem, and whether all potentially reversible conditions, such as a drug overdose, have been ruled out.

• #63 Controversy over the definition of brain death : Shots – Health News : NPR

  https://www.npr.org/sections/health-shots/2024/02/11/1228330149/brain-death-definition

  The debate is focused on the Uniform Determination of Death Act, a law that was adopted by most states in the 1980s. The law says that death can be declared if someone has experienced „irreversible cessation of all functions of the entire brain.” […] Many experts say the discrepancy needs to be resolved to protect patients and their families, maintain public trust and reconcile what some see as a troubling disconnect between the law and medical practice. […] For years, doctors have declared brain death using a series of tests to determine four main criteria: whether a person has a profound and irreversible coma, has permanently lost the capacity to breathe, has permanently lost all reflexes controlled by the brainstem, and whether all potentially reversible conditions, such as a drug overdose, have been ruled out.

• #64 Controversy over the definition of brain death : Shots – Health News : NPR

  https://www.npr.org/sections/health-shots/2024/02/11/1228330149/brain-death-definition

  The debate is focused on the Uniform Determination of Death Act, a law that was adopted by most states in the 1980s. The law says that death can be declared if someone has experienced „irreversible cessation of all functions of the entire brain.” […] Many experts say the discrepancy needs to be resolved to protect patients and their families, maintain public trust and reconcile what some see as a troubling disconnect between the law and medical practice. […] For years, doctors have declared brain death using a series of tests to determine four main criteria: whether a person has a profound and irreversible coma, has permanently lost the capacity to breathe, has permanently lost all reflexes controlled by the brainstem, and whether all potentially reversible conditions, such as a drug overdose, have been ruled out.

• #65 Controversy over the definition of brain death : Shots – Health News : NPR

  https://www.npr.org/sections/health-shots/2024/02/11/1228330149/brain-death-definition

  Critics point to rare cases like Jahi McMath, a 13-year-old girl who was declared brain dead in 2013. Her family refused to withdraw life support for years. […] But many other neurologists, bioethicists and others argue that there’s no way to make sure every neuron in the brain has ceased functioning. […] „There has never, ever been a case of a person correctly diagnosed as brain dead where that person has recovered any degree of consciousness,” agrees Dr. Robert Truog, a Harvard University professor of bioethics, anesthesiology and pediatrics. […] The American Academy of Neurology proposes putting into law only three specific criteria for the determination of death by neurologic criteria. […] Some doctors and advocates would like to do away with brain death entirely. Others call for additional testing to rule out functioning of the hypothalamus.

• #66 Controversy over the definition of brain death : Shots – Health News : NPR

  https://www.npr.org/sections/health-shots/2024/02/11/1228330149/brain-death-definition

  Critics point to rare cases like Jahi McMath, a 13-year-old girl who was declared brain dead in 2013. Her family refused to withdraw life support for years. […] But many other neurologists, bioethicists and others argue that there’s no way to make sure every neuron in the brain has ceased functioning. […] „There has never, ever been a case of a person correctly diagnosed as brain dead where that person has recovered any degree of consciousness,” agrees Dr. Robert Truog, a Harvard University professor of bioethics, anesthesiology and pediatrics. […] The American Academy of Neurology proposes putting into law only three specific criteria for the determination of death by neurologic criteria. […] Some doctors and advocates would like to do away with brain death entirely. Others call for additional testing to rule out functioning of the hypothalamus.

• #67 Controversy over the definition of brain death : Shots – Health News : NPR

  https://www.npr.org/sections/health-shots/2024/02/11/1228330149/brain-death-definition

  Critics point to rare cases like Jahi McMath, a 13-year-old girl who was declared brain dead in 2013. Her family refused to withdraw life support for years. […] But many other neurologists, bioethicists and others argue that there’s no way to make sure every neuron in the brain has ceased functioning. […] „There has never, ever been a case of a person correctly diagnosed as brain dead where that person has recovered any degree of consciousness,” agrees Dr. Robert Truog, a Harvard University professor of bioethics, anesthesiology and pediatrics. […] The American Academy of Neurology proposes putting into law only three specific criteria for the determination of death by neurologic criteria. […] Some doctors and advocates would like to do away with brain death entirely. Others call for additional testing to rule out functioning of the hypothalamus.

• #68 What Should We Do About the Mismatch Between Legal Criteria for Death and How Brain Death Is Diagnosed? | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/what-should-we-do-about-mismatch-between-legal-criteria-death-and-how-brain-death-diagnosed/2020-12

  One reason for the mismatch between medical and legal standards for determining BD is that accepted medical standards cannot determine irreversible cessation. […] Although broad religious, ethical, clinical, and legal consensus exists that death is irreversible and final, in practice, recognizing exactly when life transitions to death is not so easy. […] The AAN recently defended clinical standards for diagnosing BD in prognostic rather than in conceptual terms, stating that it was unaware of any cases in which compliant application of the Brain Death Guidelines led to inaccurate determination of death with return of any brain function. […] Despite being controversial, the McMath case is important since opportunities to longitudinally follow a patient after a BD diagnosis are few. […] In states that have adopted the UDDA, BD determination mandates the irreversible cessation of all functions of the entire brain, including the brain stem in accordance with accepted medical standards.

• #69 What Should We Do About the Mismatch Between Legal Criteria for Death and How Brain Death Is Diagnosed? | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/what-should-we-do-about-mismatch-between-legal-criteria-death-and-how-brain-death-diagnosed/2020-12

  One reason for the mismatch between medical and legal standards for determining BD is that accepted medical standards cannot determine irreversible cessation. […] Although broad religious, ethical, clinical, and legal consensus exists that death is irreversible and final, in practice, recognizing exactly when life transitions to death is not so easy. […] The AAN recently defended clinical standards for diagnosing BD in prognostic rather than in conceptual terms, stating that it was unaware of any cases in which compliant application of the Brain Death Guidelines led to inaccurate determination of death with return of any brain function. […] Despite being controversial, the McMath case is important since opportunities to longitudinally follow a patient after a BD diagnosis are few. […] In states that have adopted the UDDA, BD determination mandates the irreversible cessation of all functions of the entire brain, including the brain stem in accordance with accepted medical standards.

• #70 What Should We Do About the Mismatch Between Legal Criteria for Death and How Brain Death Is Diagnosed? | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/what-should-we-do-about-mismatch-between-legal-criteria-death-and-how-brain-death-diagnosed/2020-12

  One reason for the mismatch between medical and legal standards for determining BD is that accepted medical standards cannot determine irreversible cessation. […] Although broad religious, ethical, clinical, and legal consensus exists that death is irreversible and final, in practice, recognizing exactly when life transitions to death is not so easy. […] The AAN recently defended clinical standards for diagnosing BD in prognostic rather than in conceptual terms, stating that it was unaware of any cases in which compliant application of the Brain Death Guidelines led to inaccurate determination of death with return of any brain function. […] Despite being controversial, the McMath case is important since opportunities to longitudinally follow a patient after a BD diagnosis are few. […] In states that have adopted the UDDA, BD determination mandates the irreversible cessation of all functions of the entire brain, including the brain stem in accordance with accepted medical standards.

• #71 What Should We Do About the Mismatch Between Legal Criteria for Death and How Brain Death Is Diagnosed? | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/what-should-we-do-about-mismatch-between-legal-criteria-death-and-how-brain-death-diagnosed/2020-12

  One reason for the mismatch between medical and legal standards for determining BD is that accepted medical standards cannot determine irreversible cessation. […] Although broad religious, ethical, clinical, and legal consensus exists that death is irreversible and final, in practice, recognizing exactly when life transitions to death is not so easy. […] The AAN recently defended clinical standards for diagnosing BD in prognostic rather than in conceptual terms, stating that it was unaware of any cases in which compliant application of the Brain Death Guidelines led to inaccurate determination of death with return of any brain function. […] Despite being controversial, the McMath case is important since opportunities to longitudinally follow a patient after a BD diagnosis are few. […] In states that have adopted the UDDA, BD determination mandates the irreversible cessation of all functions of the entire brain, including the brain stem in accordance with accepted medical standards.

• #72 What Should We Do About the Mismatch Between Legal Criteria for Death and How Brain Death Is Diagnosed? | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/what-should-we-do-about-mismatch-between-legal-criteria-death-and-how-brain-death-diagnosed/2020-12

  However, accepted diagnostic tests only enable a physician to examine a patient’s motoric responses, which are controlled by the brain stem. […] Other examples illustrating the mismatch between accepted medical standards for diagnosing BD and the whole-brain criterion of BD codified in law are patients diagnosed as brain dead per accepted medical standards but who retain neurohormonal functions, such as vasopressin release, which requires an intact neurosecretory hypothalamus. […] Although preserved brain structure and blood flow do not necessarily imply preserved function, it seems clear that many young brain-dead patients have sustained blood circulation for long periods after a BD diagnosis. […] Although the UDDA requires irreversible cessation of all functions of the entire brain to diagnose BD, accepted medical standards are only achievable through physicians’ use of currently available diagnostic tests, which do not assess function loss irreversibility or brain functions other than motor responses and respiration.

• #73 What Should We Do About the Mismatch Between Legal Criteria for Death and How Brain Death Is Diagnosed? | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/what-should-we-do-about-mismatch-between-legal-criteria-death-and-how-brain-death-diagnosed/2020-12

  However, accepted diagnostic tests only enable a physician to examine a patient’s motoric responses, which are controlled by the brain stem. […] Other examples illustrating the mismatch between accepted medical standards for diagnosing BD and the whole-brain criterion of BD codified in law are patients diagnosed as brain dead per accepted medical standards but who retain neurohormonal functions, such as vasopressin release, which requires an intact neurosecretory hypothalamus. […] Although preserved brain structure and blood flow do not necessarily imply preserved function, it seems clear that many young brain-dead patients have sustained blood circulation for long periods after a BD diagnosis. […] Although the UDDA requires irreversible cessation of all functions of the entire brain to diagnose BD, accepted medical standards are only achievable through physicians’ use of currently available diagnostic tests, which do not assess function loss irreversibility or brain functions other than motor responses and respiration.

• #74 What Should We Do About the Mismatch Between Legal Criteria for Death and How Brain Death Is Diagnosed? | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/what-should-we-do-about-mismatch-between-legal-criteria-death-and-how-brain-death-diagnosed/2020-12

  This mismatch between legal criteria and what’s achievable via currently available tests for diagnosing BD means that false-positive diagnoses of BD are possible in cases of low but not absent brain perfusion or brain stem destruction. […] A second strategy is to amend the UDDA to align it more closely with clinical practice. […] Since death is difficult to define and since transitions from living, to dying, to death resemble a continuum more than they resemble the binary concept currently enshrined in law, amendment would be reasonable. […] A third strategy involves preserving BD as defined in the UDDA, while accepting that tests for BD offer only approximations of BD. […] Since it might be impossible to conclusively demonstrate irreversibility and loss of all brain functions, acknowledging the limitations of accepted standards is more intellectually honest and might help overcome public misperceptions and mistrust.

• #75 Brain death: a clinical overview | Journal of Intensive Care | Full Text

  https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-022-00609-4

  The minimum age to determine BD/DNC varies by country, ranging from 36 to 37 weeks gestation. […] It is imperative that determination of BD/DNC be standardized as much as possible throughout the world, including among institutions and among providers themselves in order to maintain public and professional confidence in brain death evaluations and ensure consistency.

• #76 Determining Brain Death: No Room for Error | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/determining-brain-death-no-room-error/2010-11

  Nearly 30 years after the Uniform Determination of Death Act, and 15 years after the initial American Academy of Neurology guidelines, continued variability in the determination of BD from state to state, hospital to hospital, and, most likely, physician to physician undermines the validity of the concept in the minds of practitioners and the public alike. […] A national consensus panel representing expert opinion and knowledge of the published literature should meet regularly to review and revise national standards as necessary, given the ever-evolving state of medical science and technology. […] Standards and policies are only the first step, however. […] A standardized, rigorous approach to BD determination is something that we owe our patients and their familiesfor in such a diagnosis, there is no room for correcting mistakes.

• #77 Determining Brain Death: No Room for Error | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/determining-brain-death-no-room-error/2010-11

  Nearly 30 years after the Uniform Determination of Death Act, and 15 years after the initial American Academy of Neurology guidelines, continued variability in the determination of BD from state to state, hospital to hospital, and, most likely, physician to physician undermines the validity of the concept in the minds of practitioners and the public alike. […] A national consensus panel representing expert opinion and knowledge of the published literature should meet regularly to review and revise national standards as necessary, given the ever-evolving state of medical science and technology. […] Standards and policies are only the first step, however. […] A standardized, rigorous approach to BD determination is something that we owe our patients and their familiesfor in such a diagnosis, there is no room for correcting mistakes.

• #78 Quick Take: Epidemiology of brain death in pediatric intensive care units in the United States | 2 Minute Medicine

  https://www.2minutemedicine.com/quick-take-epidemiology-of-brain-death-in-pediatric-intensive-care-units-in-the-united-states/

  Quick Take: Epidemiology of brain death in pediatric intensive care units in the United States […] In the United States, brain death is exclusively diagnosed in critical care settings, owing to the need for mechanical ventilatory support. […] In this national database study of 15,344 patients who died in pediatric intensive care units (PICUs), data on patient deaths were abstracted to characterize the epidemiology and clinical characteristics of pediatric patients declared brain dead in the US (2012-2017). Researchers found that of those patients who had died, 20.7% had been declared brain dead. […] This study therefore showed that brain death occurred in at least 20% of PICU deaths, with most resulting from acute hypoxic-ischemic or traumatic brain injury. […] Physician education, standardization of brain death protocols, and the use of precise, consistent language are important to ensure the integrity of brain death determination.

• #79 Incidence of brain death in the United States – PubMed

  https://pubmed.ncbi.nlm.nih.gov/32442805/

  Objectives: The epidemiological analysis of brain death (BD) can assist physicians in their development of relevant guidelines regarding training and action protocols. This study aims to find the incidence of BD in the United States. […] In recent years, the incidence of BD has increased in the United States. Knowing the incidence of BD and the establishment of long-term programs that raise awareness about BD may increase the number of potential organ donors in the future.

• #80 Brain death: a review | Egyptian Journal of Neurosurgery | Full Text

  https://ejns.springeropen.com/articles/10.1186/s41984-024-00269-6

  To date, the recognized medical criteria for BD/DNC (brain death/death according to neurological criteria) in the USA (United States of America) are the 2010 AAN (American Academy of Neurology) standards for identification of the BD/DNC for adult age and the 2011 Society of Critical Care Medicine/Child Neurology Society/American Academy of Pediatrics standards for identification of BD/DNC in Pediatrics. […] This provoked the construction of the worldwide Brain Death Project that declared a global agreement report on the BD/DNC which is accredited by 5 international federations and 27 medical professional communities from all over the world. […] The current review explores the history of BD/DNC, the scientific criteria for its identification, and some of the associated confronts. […] Though the definition of death should be constant between clinicians and hospitals, and nations to certify that whoever is considered dead somewhere will not be regarded as alive in another place, discrepancy happens in the diagnostic criteria, clinical and apnea testing. This provoked the construction of the worldwide Brain Death Project (known as WBDP), that announced a worldwide agreement report on BD/DNC and was accredited by 5 international federations and 27 medical professional communities from all over the world.

• #81 Brain death: a review | Egyptian Journal of Neurosurgery | Full Text

  https://ejns.springeropen.com/articles/10.1186/s41984-024-00269-6

  Currently, only 70 countries approve the practice of BD/DNC for defining death. However, a worldwide consensus and uniform solid guidelines are mandatory to prevent discrepancies and variations in this regard. […] The BD/DNC assessment must only be achieved by qualified experts who are skilled in providing medical service for cases with serious brain insults and got competent in family counseling and BD/DNC determination. […] The BD/DNC evaluation must be limited to unconscious apneic patients with concomitant loss of brainstem reflexes and the presence of an evident cause for permanent brain damage. […] According to WBDP, ancillary tests are obligatory in the case of pure brainstem pathology if the whole-brain formulation was pursued.

• #82 Brain death: a review | Egyptian Journal of Neurosurgery | Full Text

  https://ejns.springeropen.com/articles/10.1186/s41984-024-00269-6

  Currently, only 70 countries approve the practice of BD/DNC for defining death. However, a worldwide consensus and uniform solid guidelines are mandatory to prevent discrepancies and variations in this regard. […] The BD/DNC assessment must only be achieved by qualified experts who are skilled in providing medical service for cases with serious brain insults and got competent in family counseling and BD/DNC determination. […] The BD/DNC evaluation must be limited to unconscious apneic patients with concomitant loss of brainstem reflexes and the presence of an evident cause for permanent brain damage. […] According to WBDP, ancillary tests are obligatory in the case of pure brainstem pathology if the whole-brain formulation was pursued.

• #83 Brain death: a review | Egyptian Journal of Neurosurgery | Full Text

  https://ejns.springeropen.com/articles/10.1186/s41984-024-00269-6

  Currently, only 70 countries approve the practice of BD/DNC for defining death. However, a worldwide consensus and uniform solid guidelines are mandatory to prevent discrepancies and variations in this regard. […] The BD/DNC assessment must only be achieved by qualified experts who are skilled in providing medical service for cases with serious brain insults and got competent in family counseling and BD/DNC determination. […] The BD/DNC evaluation must be limited to unconscious apneic patients with concomitant loss of brainstem reflexes and the presence of an evident cause for permanent brain damage. […] According to WBDP, ancillary tests are obligatory in the case of pure brainstem pathology if the whole-brain formulation was pursued.

• #84 Brain death: a review | Egyptian Journal of Neurosurgery | Full Text

  https://ejns.springeropen.com/articles/10.1186/s41984-024-00269-6

  Currently, only 70 countries approve the practice of BD/DNC for defining death. However, a worldwide consensus and uniform solid guidelines are mandatory to prevent discrepancies and variations in this regard. […] The BD/DNC assessment must only be achieved by qualified experts who are skilled in providing medical service for cases with serious brain insults and got competent in family counseling and BD/DNC determination. […] The BD/DNC evaluation must be limited to unconscious apneic patients with concomitant loss of brainstem reflexes and the presence of an evident cause for permanent brain damage. […] According to WBDP, ancillary tests are obligatory in the case of pure brainstem pathology if the whole-brain formulation was pursued.

• #85 Updated Brain Death Guidance: What Care Teams Need to Know | SCCM

  https://www.sccm.org/communications/sccm-podcast/sccm-podcast-all-episodes/sccm-pod-533-ccm-updated-brain-death-guidance-what-critical-care-teams-need-to-know

  Host Diane C. McLaughlin, DNP, AGACNP-BC, CCRN, FCCM, welcomes Matthew Kirschen, MD, PhD, FAAN, FNCS, to discuss what critical care professionals need to know about determining brain death/death by neurologic criteria (BD/DNC). In October 2023, a revised consensus practice guideline for the determination of brain death in both children and adults was published in Neurology (Greer DM, et al. Neurology. 2023;101;1112-1132). The guideline integrated guidance for adults and children to provide a comprehensive, practical way to evaluate patients with catastrophic brain injuries to determine whether they meet the criteria for brain death. […] The big thing in this set of guidelines is that we amalgamated the adult criteria and the pediatric criteria into one document. […] One of the things that we did is we added recommendations for special situations, for example, evaluating pregnant persons for brain death, doing the apnea test, and the rest of the evaluation in patients supported on VA and VV ECMO.

• #86 Updated Brain Death Guidance: What Care Teams Need to Know | SCCM

  https://www.sccm.org/communications/sccm-podcast/sccm-podcast-all-episodes/sccm-pod-533-ccm-updated-brain-death-guidance-what-critical-care-teams-need-to-know

  Host Diane C. McLaughlin, DNP, AGACNP-BC, CCRN, FCCM, welcomes Matthew Kirschen, MD, PhD, FAAN, FNCS, to discuss what critical care professionals need to know about determining brain death/death by neurologic criteria (BD/DNC). In October 2023, a revised consensus practice guideline for the determination of brain death in both children and adults was published in Neurology (Greer DM, et al. Neurology. 2023;101;1112-1132). The guideline integrated guidance for adults and children to provide a comprehensive, practical way to evaluate patients with catastrophic brain injuries to determine whether they meet the criteria for brain death. […] The big thing in this set of guidelines is that we amalgamated the adult criteria and the pediatric criteria into one document. […] One of the things that we did is we added recommendations for special situations, for example, evaluating pregnant persons for brain death, doing the apnea test, and the rest of the evaluation in patients supported on VA and VV ECMO.

• #87 Updated Brain Death Guidance: What Care Teams Need to Know | SCCM

  https://www.sccm.org/communications/sccm-podcast/sccm-podcast-all-episodes/sccm-pod-533-ccm-updated-brain-death-guidance-what-critical-care-teams-need-to-know

  The 2023 multi-society guideline statement that we have been talking about here is considered the accepted medical standard. It is based on the whole brain formulation of death. […] The guidelines do a good job of addressing that. […] Hospitals need to take the guidelines and they need to revise their institutional protocols to be consistent with the guidelines, keeping in mind state and local laws and regulations that also need to be adhered to. […] This is an area where weve got to be 100% right 100% of the time.

• #88 Updated Brain Death Guidance: What Care Teams Need to Know | SCCM

  https://www.sccm.org/communications/sccm-podcast/sccm-podcast-all-episodes/sccm-pod-533-ccm-updated-brain-death-guidance-what-critical-care-teams-need-to-know

  The 2023 multi-society guideline statement that we have been talking about here is considered the accepted medical standard. It is based on the whole brain formulation of death. […] The guidelines do a good job of addressing that. […] Hospitals need to take the guidelines and they need to revise their institutional protocols to be consistent with the guidelines, keeping in mind state and local laws and regulations that also need to be adhered to. […] This is an area where weve got to be 100% right 100% of the time.

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