Materiały źródłowe

• #1 Brain death – Wikipedia

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

  Brain death is the permanent, irreversible, and complete loss of brain function, which may include cessation of involuntary activity (e.g., breathing) necessary to sustain life. […] Causes include cardiac arrest, myocardial infarction, stroke, and blood clot. […] Brain death is a medicolegal death of a person due to the complete and irreversible loss of all brain functions, including the brain stem. […] The diagnosis of brain death is often required to be highly rigorous, in order to be certain that the condition is irreversible. […] Brain death can sometimes be difficult to differentiate from other medical states such as barbiturate overdose, acute alcohol poisoning, sedative overdose, hypothermia, hypoglycemia, coma, and chronic vegetative states. […] The continuing function of vital organs in the bodies of those diagnosed brain-dead, if mechanical ventilation and other life-support measures are continued, provides optimal opportunities for their transplantation.

• #1 Brain Death – StatPearls – NCBI Bookshelf

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

  Brain death occurs as a result of an acute catastrophic brain injury. Abrupt loss of cerebral perfusion occurs if a concomitant elevation of intracranial pressure exceeds the mean arterial pressure. The formula is as follows: cerebral perfusion pressure (CPP) = mean arterial pressure (MAP) – intracranial pressure (ICP). This process was studied by monitoring brain tissue oxygenation in patients with brain death and can occur via 2 different mechanisms: […] Intracranial causes: In adults, the predominant intracranial injuries leading to brain death are traumatic brain injuries (TBI) and subarachnoid hemorrhage. These injuries elevate intracranial pressure (ICP), impair cerebral perfusion, and reduce brain tissue oxygenation, leading to neuronal damage. In pediatric cases, nonaccidental trauma is a common cause, contributing to increased ICP and subsequent brain injury.

• #2 What It Means to Be Declared Brain Dead

  https://www.verywellhealth.com/brain-death-what-does-it-mean-3157217

  Brain death is a clinical and legal definition of death. […] Major loss of brain function results in brain death. […] A few major medical conditions can lead to brain death, such as: Stroke, Heart attack, Head trauma, Oxygen starvation, A brain tumor, A brain infection such as encephalitis. […] Brain death means that a qualified physician, typically a neurologist, did an extensive physical examination and documented brain death criteria. […] Brain death means a person’s brain has been significantly damaged and has lost important function. […] A person who is brain-dead feels no pain and will not recover.

• #2

  https://journals.lww.com/neur/fulltext/2018/66020/brain_death_revisited.5.aspx

  A vicious cycle is established in which decreasing cerebral perfusion and increasing ICP reinforce one another until blood no longer enters the cranial cavity and transtentorial herniation and coning at the foramen magnum occurs. […] This herniation crushes the brain-stem leading to permanent dysfunction. […] Total loss of neurophysiological functions of the brain for more than 8 minutes confirms total and irreversible loss of brain function. […] Clinical guidelines for determining brain death are not consistently validated by the presence of irreversible brain stem ischemic injury or necrosis at autopsy. […] Several critical brain structures remain viable and continue integrated neurological functioning after clinically determined brain (stem) death occurs. […] Brain stem death has a lower burden of proof than whole-brain death.

• #3 The diagnosis of brain death

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2772257/

  Physicians need not be, or consult with, a neurologist or neurosurgeon in order to determine brain death. […] The determination of brain death requires the identification of the proximate cause and irreversibility of coma. Severe head injury, hypertensive intracerebral hemorrhage, aneurysmal subarachnoid hemorrhage, hypoxic-ischemic brain insults and fulminant hepatic failure are potential causes of irreversible loss of brain function. […] The diagnosis of brain death is primarily clinical. No other tests are required if the full clinical examination, including each of two assessments of brain stem reflexes and a single apnoea test, are conclusively performed. […] Brain death is defined as the irreversible loss of all functions of the brain, including the brainstem. The three essential findings in brain death are coma, absence of brainstem reflexes, and apnoea. An evaluation for brain death should be considered in patients who have suffered a massive, irreversible brain injury of identifiable cause.

• #4

  https://link.springer.com/article/10.1007/s44202-024-00183-w

  Receiving a diagnosis of brain stem death poses significant challenges for families. […] The review underscores the pervasive lack of understanding among families regarding the diagnosis and process of brain stem death, as well as the short- and long-term distress it can engender. […] Despite the first definition of brain stem death (BSD) being identified in 1968 by the Harvard Medical School, there still is not a universally shared concept or recognition accepted. General understanding of BSD is the permanent and total loss of all brain function in the brainstem and cerebrum when oxygen or blood supply to the brain is stopped. […] Prior to testing for BSD, proof is required to confirm that there is irreversible structural brain damage, and that all possibility of a reversible cause of coma can be excluded.

• #5

  https://npistanbul.com/en/what-is-brain-death

  Brain death is usually caused by serious head injuries, brain hemorrhages, stroke or prolonged oxygen deprivation. […] Brain death occurs when the brain is irreversibly damaged as a result of a complete loss of oxygen and blood supply. This is usually caused by the following serious medical conditions: […] Severe damage to the skull and brain due to traffic accidents, falls or severe blows can lead to brain death. […] Severe damage to the brain as a result of ruptured or burst brain vessels can cause the brain to stop functioning. […] When the blood supply to the brain is cut off or there is a lack of oxygen due to a clot, this can cause irreversible damage to brain tissue. […] When the brain is deprived of oxygen for a long period of time due to cardiac arrest, drowning, severe allergic reactions or blocked airways, the cells die completely.

• #6

  https://www.nhs.uk/conditions/brain-death/diagnosis/

  There are a number of criteria for diagnosing brain death. […] For a diagnosis of brain death: a person must be unconscious and fail to respond to outside stimulation […] there must be clear evidence that serious brain damage has occurred and it cannot be cured. […] The diagnosis of brain death has to be made by 2 doctors, and at least 1 of them must be a senior doctor. […] Brain death is diagnosed if a person fails to respond to all of these tests. […] These movements are spinal reflexes and do not involve the brain at all. They will not change the diagnosis of brain death.

• #7 Brain Death – EMCrit Project

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

  Defined as irreversible cessation of all cerebral and brainstem functioning. […] Brain death is legally recognized as equivalent to cardiopulmonary death in the United States. […] Brain death is defined by a strict set of criteria that, once met, confers zero likelihood of awakening from coma. […] Regardless of the initial injury, eventually brain death occurs via a spiral of progressive intracranial hypertension, tissue damage, and edema. This is essentially an intracranial compartment syndrome. […] Complete brain death occurs when there is complete circulatory arrest of the brain no blood is entering the brain. […] Common causes of brain death (if present, these support the diagnosis of brain death) include traumatic brain injury, intracranial hemorrhage, anoxic brain injury (usually due to cardiopulmonary arrest), fulminant meningitis or encephalitis, fulminant hepatic failure causing cerebral edema, and ischemic stroke with cerebral edema and herniation. […] Brain death evaluation is a standard component of medical care. […] Once the patient has been declared brain dead they are deceased (brain dead is dead).

• #8 Diagnosis of brain death – UpToDate

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

  Death of the brain therefore qualifies as death, as the brain is essential for integrating critical functions of the body. […] 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.

• #9

  https://npistanbul.com/en/what-is-brain-death

  Malignant tumors growing in the brain can put pressure on the surrounding tissues and stop the brain from functioning. […] Serious infections affecting the brain and spinal cord (such as meningitis or encephalitis) can cause the brain to stop functioning. […] Poisoning due to alcohol, drugs or chemicals can irreversibly stop the brain from functioning. […] Severe sodium, potassium or glucose irregularities in the body can lead to a complete loss of brain function. […] Swelling and increased pressure in the brain can compress the brain stem and stop all brain functions. […] These causes of brain death usually occur as a result of sudden and severe events. Therefore, early intervention and rapid medical assistance are vital. However, brain death is an irreversible condition and from this point on, a person’s life can only be sustained with life support devices.

• #10 Brain Death | UMass Memorial Health

  https://www.ummhealth.org/health-library/brain-death

  Brain death means the brain no longer functions. No blood is flowing to the brain. The thinking part of the brain (cerebrum) as well as the part of the brain responsible for breathing and reflexes (brain stem) no longer work. […] Brain death means the brain no longer functions. No blood is flowing to the brain. The thinking part of the brain (cerebrum) as well as the part of the brain responsible for breathing and reflexes (brain stem) no longer work. Brain death is diagnosed when 3 conditions exist. […] Any major injury to the brain can cause brain death. This includes things such as a stroke, injury from an accident, lack of oxygen to the brain such as from drowning or cardiac arrest, a brain infection, or liver failure. Brain death cannot be reversed.

• #11 Brain Death – StatPearls – NCBI Bookshelf

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

  Extracranial causes: In both adults and children, a significant extracranial cause of brain death is cardiopulmonary arrest with delayed or inadequate resuscitation. This leads to prolonged cessation of cerebral blood flow, resulting in anoxia, cellular membrane pump failure, disturbed osmoregulation, and severe brain edema. The increased ICP within the confined space of the skull further compromises cerebral perfusion, exacerbating neuronal injury.

• #12 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. […] In all age categories, a known extracranial or intracranial etiology may be responsible for brain death which happens next to significant damage of the brain neuronal cells resulting in permanent coma (loss of consciousness), absent brainstem reflexes, and apnea. After exclusion of unusual situations such as drug poisoning, extreme electrolyte imbalance, and endocrinal disorders, many causes are defined and confirmed as an acute and permanent etiology for brain death. In adults, intracranial causes like head trauma or subarachnoid hemorrhage are commonly seen, while non-accidental trauma is a common cause in pediatrics. The commonly faced extracranial cause is cardiopulmonary arrest.

• #13

  https://www.nhs.uk/conditions/brain-death/

  Brain death can happen when the blood or oxygen supply to the brain is stopped. […] This can be caused by: cardiac arrest when the heart stops beating and the brain is starved of oxygen, a heart attack when the blood supply to the heart is suddenly blocked, a stroke when the blood supply to the brain is blocked or interrupted, a blood clot a blockage in a blood vessel that disturbs or blocks the flow of blood around your body. […] Brain death can also be caused by: a severe head injury, a brain haemorrhage, infections, such as encephalitis, a brain tumour.

• #14

  https://111.wales.nhs.uk/encyclopaedia/b/article/braindeath

  Brain death (also known as brain stem death) is when a person on an artificial life support machine no longer has any brain functions. This means they will not regain consciousness or be able to breathe without support. […] A person who is brain dead is legally confirmed as dead. They have no chance of recovery because their body is unable to survive without artificial life support. […] Brain death can happen when the blood and/or oxygen supply to the brain is stopped. […] This can be caused by: cardiac arrest when the heart stops beating and the brain is starved of oxygen, a heart attack when the blood supply to the heart is suddenly blocked, a stroke when the blood supply to the brain is blocked or interrupted, a blood clot a blockage in a blood vessel that disturbs or blocks the flow of blood around your body. […] Brain death can also be caused by: a severe head injury, a brain haemorrhage, infections, such as encephalitis, a brain tumour.

• #15 What Is Brain Death?

  https://www.icliniq.com/articles/neurological-health/brain-death

  Brain death occurs due to various causes, but the base for every reason is the blockage of oxygen to the brain. […] The common causes of brain death include; A Serious Head Injury – Damage to the blood vessels in and around the head can block the oxygen supply to the brain, thereby causing brain death. […] Blood Clots or Bleeding in the Brain – Blood clots in the brain’s blood vessels or other parts of the body that block the blood from reaching the brain or a brain hemorrhage (bleeding inside the brain) due to leakage from the blood vessels cause brain death. […] Stroke – It is a condition that results from either a blood clot or a brain hemorrhage, also responsible for brain death. […] Heart Attack- A heart attack is when the blood supply to the heart is blocked suddenly. As the heart stops beating, the brain is denied oxygen too. After a while, brain death could occur due to the lack of blood supply. […] Cardiac Arrest – A condition in which the heart stops functioning and can also cause brain death. […] Infections in the Brain – Infections such as encephalitis (inflammation in the brain) and brain abscesses can also cause brain death.

• #16 Understanding brain stem death – a guide for relatives : University College London Hospitals NHS Foundation Trust

  https://www.uclh.nhs.uk/patients-and-visitors/patient-information-pages/brain-stem-death

  Many people do not realise that we can confirm someone has died in two ways: […] When brain stem death has been confirmed it means that person has legally died. […] Brain stem death happens when the brain has been injured in some way. Examples of these causes are: a head injury, bleeding into or around the brain, a tumour, a drug overdose, poisoning, suffocation or drowning. […] When this happens, blood and oxygen cannot reach the brain and it dies.

• #17

  https://npistanbul.com/en/what-is-brain-death

  Brain death is usually caused by serious head injuries, brain hemorrhages, stroke or prolonged oxygen deprivation. […] Brain death occurs when the brain is irreversibly damaged as a result of a complete loss of oxygen and blood supply. This is usually caused by the following serious medical conditions: […] Severe damage to the skull and brain due to traffic accidents, falls or severe blows can lead to brain death. […] Severe damage to the brain as a result of ruptured or burst brain vessels can cause the brain to stop functioning. […] When the blood supply to the brain is cut off or there is a lack of oxygen due to a clot, this can cause irreversible damage to brain tissue. […] When the brain is deprived of oxygen for a long period of time due to cardiac arrest, drowning, severe allergic reactions or blocked airways, the cells die completely.

• #18 Brain Death: Coma and the Persistent Vegetative State

  https://www.prepladder.com/neet-pg-study-material/medicine/brain-death-causes-symptoms-diagnosis-difference-between-brain-beath-coma-and-the-persistent-vegetative-state

  Metabolic Disorders: Some rare genetic or acquired metabolic disorders can lead to brain death. […] Drug Overdose: Overdosing on certain drugs particularly those that depress the central nervous system such as opioids or sedatives, can cause respiratory depression and subsequent brain damage If oxygen supply is compromised for an extended period.

• #19

  https://npistanbul.com/en/what-is-brain-death

  Malignant tumors growing in the brain can put pressure on the surrounding tissues and stop the brain from functioning. […] Serious infections affecting the brain and spinal cord (such as meningitis or encephalitis) can cause the brain to stop functioning. […] Poisoning due to alcohol, drugs or chemicals can irreversibly stop the brain from functioning. […] Severe sodium, potassium or glucose irregularities in the body can lead to a complete loss of brain function. […] Swelling and increased pressure in the brain can compress the brain stem and stop all brain functions. […] These causes of brain death usually occur as a result of sudden and severe events. Therefore, early intervention and rapid medical assistance are vital. However, brain death is an irreversible condition and from this point on, a person’s life can only be sustained with life support devices.

• #20 Brain Death – StatPearls – NCBI Bookshelf

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

  Brain death occurs as a result of an acute catastrophic brain injury. Abrupt loss of cerebral perfusion occurs if a concomitant elevation of intracranial pressure exceeds the mean arterial pressure. The formula is as follows: cerebral perfusion pressure (CPP) = mean arterial pressure (MAP) – intracranial pressure (ICP). This process was studied by monitoring brain tissue oxygenation in patients with brain death and can occur via 2 different mechanisms: […] Intracranial causes: In adults, the predominant intracranial injuries leading to brain death are traumatic brain injuries (TBI) and subarachnoid hemorrhage. These injuries elevate intracranial pressure (ICP), impair cerebral perfusion, and reduce brain tissue oxygenation, leading to neuronal damage. In pediatric cases, nonaccidental trauma is a common cause, contributing to increased ICP and subsequent brain injury.

• #21 Brain Death – StatPearls – NCBI Bookshelf

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

  Brain death occurs as a result of an acute catastrophic brain injury. Abrupt loss of cerebral perfusion occurs if a concomitant elevation of intracranial pressure exceeds the mean arterial pressure. The formula is as follows: cerebral perfusion pressure (CPP) = mean arterial pressure (MAP) – intracranial pressure (ICP). This process was studied by monitoring brain tissue oxygenation in patients with brain death and can occur via 2 different mechanisms: […] Intracranial causes: In adults, the predominant intracranial injuries leading to brain death are traumatic brain injuries (TBI) and subarachnoid hemorrhage. These injuries elevate intracranial pressure (ICP), impair cerebral perfusion, and reduce brain tissue oxygenation, leading to neuronal damage. In pediatric cases, nonaccidental trauma is a common cause, contributing to increased ICP and subsequent brain injury.

• #22

  https://journals.lww.com/amjm/fulltext/2020/16020/pathophysiology_of_brain_stem_death.4.aspx

  Brain stem death (BD) is a pathological process which is characterized by hormonal impairment, hemodynamic imbalance, and a systemic inflammatory response. Knowledge about these changes is important in managing a BD donor. Three main causes of BD include traumatic brain injury (TBI), cerebrovascular injury, and anoxia. […] The American Academy of Neurology defines BD as the irreversible loss of brain and brain stem function, usually caused by major hemorrhage, hypoxia, or metabolic dysregulation. […] High intracranial pressure causes cerebral and brain stem herniation which leads to sympathetic stimulation and dysfunction of the hypothalamo-pituitary axis. […] Ischemia leads to metabolic acidosis which stimulates the releases of cytokines and activates coagulation factors and promotes leukocytic proliferation, causing systemic inflammatory pathway activation and tissue damage.

• #23 Brain Death – EMCrit Project

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

  Defined as irreversible cessation of all cerebral and brainstem functioning. […] Brain death is legally recognized as equivalent to cardiopulmonary death in the United States. […] Brain death is defined by a strict set of criteria that, once met, confers zero likelihood of awakening from coma. […] Regardless of the initial injury, eventually brain death occurs via a spiral of progressive intracranial hypertension, tissue damage, and edema. This is essentially an intracranial compartment syndrome. […] Complete brain death occurs when there is complete circulatory arrest of the brain no blood is entering the brain. […] Common causes of brain death (if present, these support the diagnosis of brain death) include traumatic brain injury, intracranial hemorrhage, anoxic brain injury (usually due to cardiopulmonary arrest), fulminant meningitis or encephalitis, fulminant hepatic failure causing cerebral edema, and ischemic stroke with cerebral edema and herniation. […] Brain death evaluation is a standard component of medical care. […] Once the patient has been declared brain dead they are deceased (brain dead is dead).

• #24

  https://journals.lww.com/neur/fulltext/2018/66020/brain_death_revisited.5.aspx

  A vicious cycle is established in which decreasing cerebral perfusion and increasing ICP reinforce one another until blood no longer enters the cranial cavity and transtentorial herniation and coning at the foramen magnum occurs. […] This herniation crushes the brain-stem leading to permanent dysfunction. […] Total loss of neurophysiological functions of the brain for more than 8 minutes confirms total and irreversible loss of brain function. […] Clinical guidelines for determining brain death are not consistently validated by the presence of irreversible brain stem ischemic injury or necrosis at autopsy. […] Several critical brain structures remain viable and continue integrated neurological functioning after clinically determined brain (stem) death occurs. […] Brain stem death has a lower burden of proof than whole-brain death.

• #25 Is brain death reversible? | Live Science

  https://www.livescience.com/brain-death-irreversible

  Brain death, also known as death by neurologic criteria isn’t just damage or a coma. It’s irreversible. […] Brain death is not reversible, because once the brain stem stops functioning, the heart and other critical organs cease to work, they cannot be repaired, and the body disintegrates. […] Brain death, also known as death by neurological criteria, is a relatively rare way to die, said Dr. Panayiotis Varelas, chair of neurology at Albany Medical College. But it can happen in cases of severe brain injury, either due to brain trauma or an extended lack of oxygen. […] In the face of trauma or a lack of oxygen, the brain cells begin to die, Varelas told Live Science. This mass die-off causes inflammation and swelling, locking the brain into a vicious feedback loop: Damage leads to swelling, which leads to more damage as delicate nerve cells are pressed against the hard case of the skull.

• #26

  https://journals.lww.com/neur/fulltext/2018/66020/brain_death_revisited.5.aspx

  A vicious cycle is established in which decreasing cerebral perfusion and increasing ICP reinforce one another until blood no longer enters the cranial cavity and transtentorial herniation and coning at the foramen magnum occurs. […] This herniation crushes the brain-stem leading to permanent dysfunction. […] Total loss of neurophysiological functions of the brain for more than 8 minutes confirms total and irreversible loss of brain function. […] Clinical guidelines for determining brain death are not consistently validated by the presence of irreversible brain stem ischemic injury or necrosis at autopsy. […] Several critical brain structures remain viable and continue integrated neurological functioning after clinically determined brain (stem) death occurs. […] Brain stem death has a lower burden of proof than whole-brain death.

• #27

  https://journals.lww.com/amjm/fulltext/2020/16020/pathophysiology_of_brain_stem_death.4.aspx

  Brain stem death (BD) is a pathological process which is characterized by hormonal impairment, hemodynamic imbalance, and a systemic inflammatory response. Knowledge about these changes is important in managing a BD donor. Three main causes of BD include traumatic brain injury (TBI), cerebrovascular injury, and anoxia. […] The American Academy of Neurology defines BD as the irreversible loss of brain and brain stem function, usually caused by major hemorrhage, hypoxia, or metabolic dysregulation. […] High intracranial pressure causes cerebral and brain stem herniation which leads to sympathetic stimulation and dysfunction of the hypothalamo-pituitary axis. […] Ischemia leads to metabolic acidosis which stimulates the releases of cytokines and activates coagulation factors and promotes leukocytic proliferation, causing systemic inflammatory pathway activation and tissue damage.

• #28 Brain Death – StatPearls – NCBI Bookshelf

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

  Brain death occurs as a result of an acute catastrophic brain injury. Abrupt loss of cerebral perfusion occurs if a concomitant elevation of intracranial pressure exceeds the mean arterial pressure. The formula is as follows: cerebral perfusion pressure (CPP) = mean arterial pressure (MAP) – intracranial pressure (ICP). This process was studied by monitoring brain tissue oxygenation in patients with brain death and can occur via 2 different mechanisms: […] Intracranial causes: In adults, the predominant intracranial injuries leading to brain death are traumatic brain injuries (TBI) and subarachnoid hemorrhage. These injuries elevate intracranial pressure (ICP), impair cerebral perfusion, and reduce brain tissue oxygenation, leading to neuronal damage. In pediatric cases, nonaccidental trauma is a common cause, contributing to increased ICP and subsequent brain injury.

• #29 Brain death in infants and children – Document – Gale OneFile: Health and Medicine

  https://go.gale.com/ps/i.do?id=GALE%7CA144875086&sid=googleScholar&v=2.1&it=r&linkaccess=abs&issn=02795442&p=HRCA&sw=w

  In 1987, guidelines for the determination of brain death in children in the United States were proposed by a task force consisting of representatives of several major professional medical and legal societies. These guidelines emphasized the importance of evaluation of the patient’s medical history and clinical examination in determining the cause of coma so that remedial or reversible conditions can be differentiated from other nonreversible causes. […] Brain death most commonly occurs after acute brain injuries. The most frequent cause of brain death in children is traumatic brain injury (30%), most often caused by child abuse and motor vehicle accidents. Asphyxial injury (14%) is also common and occurs after near drowning, as a complication of shock, from strangulation or suffocation.

• #30 Brain death in infants and children – Document – Gale OneFile: Health and Medicine

  https://go.gale.com/ps/i.do?id=GALE%7CA144875086&sid=googleScholar&v=2.1&it=r&linkaccess=abs&issn=02795442&p=HRCA&sw=w

  In 1987, guidelines for the determination of brain death in children in the United States were proposed by a task force consisting of representatives of several major professional medical and legal societies. These guidelines emphasized the importance of evaluation of the patient’s medical history and clinical examination in determining the cause of coma so that remedial or reversible conditions can be differentiated from other nonreversible causes. […] Brain death most commonly occurs after acute brain injuries. The most frequent cause of brain death in children is traumatic brain injury (30%), most often caused by child abuse and motor vehicle accidents. Asphyxial injury (14%) is also common and occurs after near drowning, as a complication of shock, from strangulation or suffocation.

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

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

  Theoretical benefits include basal cerebral metabolism reduction, prevention of free radical formation, reduction of reperfusion injury, and suppression of neuronal death pathways. […] It is important to first understand physiologic differences in pediatric populations to understand differences in the determination of BD/DNC. […] The minimum age to determine BD/DNC varies by country, ranging from 36 to 37 weeks gestation. […] Unlike in the adult population where TTM is used almost exclusively in cardiac arrest patients with temperature targets usually considered mild hypothermia, in pediatric protocols, at least moderate hypothermia is used in the setting of neonatal asphyxia, often 35 C. […] Given the general lack of high quality data to guide management of pediatric patients, a conservative approach is taken and 2 exams are recommended, often including 2 apnea tests. […] In conclusion, the concept of brain death has grown, been refined, and increasingly accepted by the scientific community and the public since its original conception in the 1950s.

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

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

  Theoretical benefits include basal cerebral metabolism reduction, prevention of free radical formation, reduction of reperfusion injury, and suppression of neuronal death pathways. […] It is important to first understand physiologic differences in pediatric populations to understand differences in the determination of BD/DNC. […] The minimum age to determine BD/DNC varies by country, ranging from 36 to 37 weeks gestation. […] Unlike in the adult population where TTM is used almost exclusively in cardiac arrest patients with temperature targets usually considered mild hypothermia, in pediatric protocols, at least moderate hypothermia is used in the setting of neonatal asphyxia, often 35 C. […] Given the general lack of high quality data to guide management of pediatric patients, a conservative approach is taken and 2 exams are recommended, often including 2 apnea tests. […] In conclusion, the concept of brain death has grown, been refined, and increasingly accepted by the scientific community and the public since its original conception in the 1950s.

• #33 Brain death – Wikipedia

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

  Brain death is the permanent, irreversible, and complete loss of brain function, which may include cessation of involuntary activity (e.g., breathing) necessary to sustain life. […] Causes include cardiac arrest, myocardial infarction, stroke, and blood clot. […] Brain death is a medicolegal death of a person due to the complete and irreversible loss of all brain functions, including the brain stem. […] The diagnosis of brain death is often required to be highly rigorous, in order to be certain that the condition is irreversible. […] Brain death can sometimes be difficult to differentiate from other medical states such as barbiturate overdose, acute alcohol poisoning, sedative overdose, hypothermia, hypoglycemia, coma, and chronic vegetative states. […] The continuing function of vital organs in the bodies of those diagnosed brain-dead, if mechanical ventilation and other life-support measures are continued, provides optimal opportunities for their transplantation.

• #34 The diagnosis of brain death

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2772257/

  The conditions that may confound clinical diagnosis of brain death are: Shock/ hypotension, Hypothermia -temperature 32C, Drugs known to alter neurologic, neuromuscular function and electroencephalographic testing, like anaesthetic agents, neuroparalytic drugs, methaqualone, barbiturates, benzodiazepines, high dose bretylium, amitryptiline, meprobamate, trichloroethylene, alcohols. […] Any of the suggested tests may produce similar results in patients with catastrophic brain damage who do not fulfill the clinical criteria of brain death.

• #35 The diagnosis of brain death

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2772257/

  The conditions that may confound clinical diagnosis of brain death are: Shock/ hypotension, Hypothermia -temperature 32C, Drugs known to alter neurologic, neuromuscular function and electroencephalographic testing, like anaesthetic agents, neuroparalytic drugs, methaqualone, barbiturates, benzodiazepines, high dose bretylium, amitryptiline, meprobamate, trichloroethylene, alcohols. […] Any of the suggested tests may produce similar results in patients with catastrophic brain damage who do not fulfill the clinical criteria of brain death.

• #36 Concepts of Brain Death – TeachMeSurgery

  https://teachmesurgery.com/transplant-surgery/core-concepts/brain-death/

  The diagnosis of brainstem death is relevant to a number of clinical situations and unfortunately is a commonly performed test in many critical care units. […] Brainstem death can be defined as the absence of brainstem reflexes, motor responses, and respiratory drive in a deeply unconscious patient with an irreversible widespread brain lesion of a known cause and no contributing metabolic derangements. […] Any patient considered for potential brainstem testing should be (1) deeply unconscious (2) apnoeic (3) mechanically ventilated; there should be certainty that the patient has sustained an irreversible brain damage of known cause. […] It is also essential to exclude or correct any reversible causes present that may account for the patients condition, prior to continuing with the testing. These include: Sedative drugs, Endocrine abnormalities, Metabolic abnormalities, Hypothermia, Cardiovascular instability. […] The apnoea test should only be performed after demonstration of absent brainstem reflexes. The test aims to demonstrate brainstem death by producing an acidaemic respiratory stimulus (pH 7.4) without inducing hypoxia or cardiovascular instability.

• #37 Confounding factors in diagnosing brain death: a case report | BMC Neurology | Full Text

  https://bmcneurol.biomedcentral.com/articles/10.1186/1471-2377-2-5

  Brain death is strictly defined medically and legally. This diagnosis depends on three cardinal neurological features: coma, absent brainstem reflexes, and apnea. The diagnosis can only be made, however, in the absence of intoxication, hypothermia, or certain medical illnesses. […] The presence of certain medical conditions prohibits a diagnosis of brain death, which is a medicolegal diagnosis of death, not a prediction or forecast of future outcome. […] Brain death is defined as the irreversible cessation of function of the entire brain with three specific criteria: 1) coma, 2) absent brainstem reflexes and 3) apnea. In addition to these clinical criteria, there are important prerequisites: 1) no drug intoxication or poisoning, 2) core temperature greater than 32 degrees Celsius, 3) clinical or neuroimaging evidence of acute central nervous system catastrophe and 4) absence of confounding medical conditions such as severe electrolyte, acid-base, or endocrine disturbances.

• #38

  https://journals.lww.com/neur/fulltext/2018/66020/brain_death_revisited.5.aspx

  Within the brain, not all cells die at the same time. […] The White Paper on Controversies in the Determination of Death published by the President’s Council on Bioethics still believes in whole-brain-death. […] Diagnosis of brain stem death does not require confirmation that all brain functions have ceased. […] The biological death of the whole human organism cannot (and is not required to) be proven during the diagnosis of brain death. […] While there is unanimity that confirmation of absence of brain stem reflexes is fundamental to the clinical determination of brain death, there are wide variations in the requirements for the conduct of the apnea test. […] Brain death should not even be thought of, until the following reversible causes of coma have been excluded. […] The clinical diagnosis of brain death should be performed in three steps: (1) Establishing the etiology; (2) excluding potentially reversible syndromes that may produce signs similar to brain death; and, (3) demonstrating clinical signs of brain death including coma, brain stem areflexia and apnea.

• #39 Concepts of Brain Death – TeachMeSurgery

  https://teachmesurgery.com/transplant-surgery/core-concepts/brain-death/

  The diagnosis of brainstem death is relevant to a number of clinical situations and unfortunately is a commonly performed test in many critical care units. […] Brainstem death can be defined as the absence of brainstem reflexes, motor responses, and respiratory drive in a deeply unconscious patient with an irreversible widespread brain lesion of a known cause and no contributing metabolic derangements. […] Any patient considered for potential brainstem testing should be (1) deeply unconscious (2) apnoeic (3) mechanically ventilated; there should be certainty that the patient has sustained an irreversible brain damage of known cause. […] It is also essential to exclude or correct any reversible causes present that may account for the patients condition, prior to continuing with the testing. These include: Sedative drugs, Endocrine abnormalities, Metabolic abnormalities, Hypothermia, Cardiovascular instability. […] The apnoea test should only be performed after demonstration of absent brainstem reflexes. The test aims to demonstrate brainstem death by producing an acidaemic respiratory stimulus (pH 7.4) without inducing hypoxia or cardiovascular instability.

• #40 JHN Journal

  https://jdc.jefferson.edu/jhnj/vol12/iss1/7/

  Accumulating evidence suggests that organs from ECMO patients can be safely transplanted after a declaration of cardiac or brain death. […] However, making a diagnosis of brain death while a patient is on ECMO poses unique challenges and limited literature exists. […] Between 1995 and 2014, we identified 26 patients on ECMO who donated organs after being diagnosed with brain death. […] This study demonstrated the variability of practice patterns in the declaration of brain death for patients on ECMO over time and the lack of understanding of the CO2 physiology on ECMO. […] Additional studies are needed to devise a national standardized protocol to declare brain death on ECMO.

• #41 Brain death – Wikipedia

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

  Brain death is the permanent, irreversible, and complete loss of brain function, which may include cessation of involuntary activity (e.g., breathing) necessary to sustain life. […] Causes include cardiac arrest, myocardial infarction, stroke, and blood clot. […] Brain death is a medicolegal death of a person due to the complete and irreversible loss of all brain functions, including the brain stem. […] The diagnosis of brain death is often required to be highly rigorous, in order to be certain that the condition is irreversible. […] Brain death can sometimes be difficult to differentiate from other medical states such as barbiturate overdose, acute alcohol poisoning, sedative overdose, hypothermia, hypoglycemia, coma, and chronic vegetative states. […] The continuing function of vital organs in the bodies of those diagnosed brain-dead, if mechanical ventilation and other life-support measures are continued, provides optimal opportunities for their transplantation.

• #42 Confounding factors in diagnosing brain death: a case report | BMC Neurology | Full Text

  https://bmcneurol.biomedcentral.com/articles/10.1186/1471-2377-2-5

  While she satisfied the cardinal neurological aspects for diagnosing brain death, the laboratory evidence indicated the presence of a confounding medical illness, thus precluding satisfaction of the necessary brain death prerequisites. […] This interesting case taught us two clinical lessons. First, the importance of recognizing that certain medical illnesses, like severe hypothyroidism, prevent diagnosing death by neurological criteria, even when the three cardinal neurological features exist. […] Our reluctance to declare brain death due to hypothyroidism led us to assess cerebral perfusion with a Technetium radionuclide scan. […] This clinical interaction demonstrates some of the medical and ethical challenges in the diagnosis of brain death. Brain death is synonymous with death and not a prognostication of future outcome. While a patient’s prognosis plays an important role in decisions about withdrawal of care, prognosis does not play a role in the medico-legal realm of declaring brain death.

• #43 Coma – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/coma/symptoms-causes/syc-20371099

  Many types of problems can cause a coma. Some examples are: […] Traumatic brain injuries. These are often caused by traffic collisions or acts of violence. […] Stroke. Reduced or stopped blood supply to the brain, known as a stroke, can result from blocked arteries or a burst blood vessel. […] Tumors. Tumors in the brain or brainstem can cause a coma. […] Diabetes. Blood sugar levels that become too high or too low can cause a coma. […] Lack of oxygen. People who have been rescued from drowning or revived after a heart attack might not awaken due to lack of oxygen to the brain. […] Infections. Infections such as encephalitis and meningitis cause swelling of the brain, spinal cord or the tissues that surround the brain. Severe cases of these infections can result in brain damage or a coma. […] Seizures. Ongoing seizures can lead to a coma. […] Toxins. Exposure to toxins, such as carbon monoxide or lead, can cause brain damage and a coma. […] Drugs and alcohol. Overdosing on drugs or alcohol can result in a coma.

• #44 Confounding factors in diagnosing brain death: a case report | BMC Neurology | Full Text

  https://bmcneurol.biomedcentral.com/articles/10.1186/1471-2377-2-5

  Brain death is strictly defined medically and legally. This diagnosis depends on three cardinal neurological features: coma, absent brainstem reflexes, and apnea. The diagnosis can only be made, however, in the absence of intoxication, hypothermia, or certain medical illnesses. […] The presence of certain medical conditions prohibits a diagnosis of brain death, which is a medicolegal diagnosis of death, not a prediction or forecast of future outcome. […] Brain death is defined as the irreversible cessation of function of the entire brain with three specific criteria: 1) coma, 2) absent brainstem reflexes and 3) apnea. In addition to these clinical criteria, there are important prerequisites: 1) no drug intoxication or poisoning, 2) core temperature greater than 32 degrees Celsius, 3) clinical or neuroimaging evidence of acute central nervous system catastrophe and 4) absence of confounding medical conditions such as severe electrolyte, acid-base, or endocrine disturbances.

• #45

  https://journals.lww.com/neur/fulltext/2018/66020/brain_death_revisited.5.aspx

  For certifying brain death, the following need to be evaluated: Presence of irreversible coma; and, the cessation of spontaneous respiration confirmed with apnea tests, absence of pupillary light reflexes, corneal reflexes, doll’s eye movements, gag reflex, cough reflex (tracheal), eye movements on caloric testing bilaterally, motor response in any cranial nerve distribution, and motor response on stimulation of face/limb/trunk. […] The exact incidence of brain death is not known. […] Brain death is usually a result of severe head injury, aneurysmal subarachnoid hemorrhage, and intracerebral hemorrhage. […] Variability in documentation of brain death has been reported. […] Severe damage to neuronal tissue leads to edema and increase in intracranial pressure (ICP). […] Elevated ICP reduces cerebral perfusion pressure and cerebral blood flow.

• #46 Death – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/death/

  Brain death: irreversible, complete loss of function of the entire brain (including the brainstem), even if cardiopulmonary functions can be upheld by artificial life support. […] Two physicians are required to make the legal diagnosis of brain death. […] Declaring brain death requires all of the following: Establish irreversible coma and the possible cause (e.g., acute severe damage to the CNS consistent with brain death as established by clinical or radiologic evidence). […] Brain death may not be established if one of the following is present in the patient: Abnormal core temperature, Abnormal systolic blood pressure, Drug effects of CNS-depressing or neuromuscular blockade drugs, Abnormal laboratory values (e.g., severe electrolyte imbalance, acid-base disturbance). […] Coma: No sign of arousal or awareness.

• #47

  https://journals.lww.com/neur/fulltext/2018/66020/brain_death_revisited.5.aspx

  Within the brain, not all cells die at the same time. […] The White Paper on Controversies in the Determination of Death published by the President’s Council on Bioethics still believes in whole-brain-death. […] Diagnosis of brain stem death does not require confirmation that all brain functions have ceased. […] The biological death of the whole human organism cannot (and is not required to) be proven during the diagnosis of brain death. […] While there is unanimity that confirmation of absence of brain stem reflexes is fundamental to the clinical determination of brain death, there are wide variations in the requirements for the conduct of the apnea test. […] Brain death should not even be thought of, until the following reversible causes of coma have been excluded. […] The clinical diagnosis of brain death should be performed in three steps: (1) Establishing the etiology; (2) excluding potentially reversible syndromes that may produce signs similar to brain death; and, (3) demonstrating clinical signs of brain death including coma, brain stem areflexia and apnea.

• #48 The diagnosis of brain death

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2772257/

  Physicians need not be, or consult with, a neurologist or neurosurgeon in order to determine brain death. […] The determination of brain death requires the identification of the proximate cause and irreversibility of coma. Severe head injury, hypertensive intracerebral hemorrhage, aneurysmal subarachnoid hemorrhage, hypoxic-ischemic brain insults and fulminant hepatic failure are potential causes of irreversible loss of brain function. […] The diagnosis of brain death is primarily clinical. No other tests are required if the full clinical examination, including each of two assessments of brain stem reflexes and a single apnoea test, are conclusively performed. […] Brain death is defined as the irreversible loss of all functions of the brain, including the brainstem. The three essential findings in brain death are coma, absence of brainstem reflexes, and apnoea. An evaluation for brain death should be considered in patients who have suffered a massive, irreversible brain injury of identifiable cause.

• #49

  https://www.nhs.uk/conditions/brain-death/diagnosis/

  There are a number of criteria for diagnosing brain death. […] For a diagnosis of brain death: a person must be unconscious and fail to respond to outside stimulation […] there must be clear evidence that serious brain damage has occurred and it cannot be cured. […] The diagnosis of brain death has to be made by 2 doctors, and at least 1 of them must be a senior doctor. […] Brain death is diagnosed if a person fails to respond to all of these tests. […] These movements are spinal reflexes and do not involve the brain at all. They will not change the diagnosis of brain death.

• #50 :: JKMS :: Journal of Korean Medical Science

  https://jkms.org/DOIx.php?id=10.3346/jkms.2020.35.e71

  Brain death is a clinical diagnosis that implies irreversible loss of function of the entire brain, including the brainstem and both hemispheres. […] Based on previous reports, it is not rare for reflex and spontaneous movements to occur in patients during the process of determining brain death. […] The most common reflex movements were the flexor/extensor plantar response and spinal myoclonus. […] Patients with hypoxic brain damage and a higher systolic blood pressure exhibited significantly more reflex or spontaneous movements. […] The causes of brain death in the 362 patients who did not exhibit movement were somewhat consistent with the distribution of the causes of brain death for all patients. […] However, hypoxic brain injury was more likely to be the cause of brain death among patients with movement than those without movement. […] In conclusion, we analyzed reflex and spontaneous movements using a large sample of brain dead patients in Korea and found that 17.0% of patients exhibited these movements during the process of brain death diagnosis; the observed frequency is lower than that reported by previous studies.

• #51

  https://journals.lww.com/neur/fulltext/2018/66020/brain_death_revisited.5.aspx

  Until six decades ago, death was considered to be a specific point in time, referring to the moment at which life ends. […] With increasing accessibility to intensive care units (ICUs) even in Tier II and Tier III cities, and the government making it mandatory to notify brain death to facilitate cadaveric organ transplants, it behooves the neurosurgeon and neurologist to totally understand the minutiae of brain death. […] Knowing the pathophysiology of brain stem dysfunction will help the clinician better understand the rationale of the mandatory clinical tests prescribed. […] The necessity for an early diagnosis and the pitfalls in the clinical diagnosis of brain death, the limitations of the so-called confirmatory tests, and the concerns and ethical issues will be highlighted. […] Review of the world literature demonstrates that there is no international consensus even on what constitutes brain death.

• #52 Brain death | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/brain-death-2?lang=us

  Brain death (or death by neurological criteria) refers to the irreversible end of all brain activity and is usually assessed clinically. […] As the diagnosis of brain death is considered equivalent to cardiac death in many jurisdictions and it allows organ donation for transplantation or withdrawal of life support, most countries have specific and varied related legal standards and practice guidelines. […] It should be noted that brain death imaging is not synonymous with identifying extensive global hypoxic-ischemic injury. […] Furthermore, it is essential to realize that the absence of brain perfusion implies brain death, but the converse is not true. […] In situations where intracranial pressure is not sufficiently elevated, perfusion can continue to occur even though there may be profound global brain infarction.

• #53 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 1959, the concept of brain death/death by neurologic criteria (BD/DNC) was first theorized as le coma dpass, by Mollaret and Goulon, who described an apneic, comatose patient without brainstem reflexes or electroencephalographic (EEG) activity. […] Neurologists began to postulate that neurologic function was equally or more vital than cardiopulmonary function, and began a process to define death neurologically, independent of other essential organ functions. […] 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.

• #54 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. […] A third but less traditional concept of brain death is the higher brain formulation, which postulates that only destruction of the higher brain, including the cortex and bilateral hemispheres, is necessary to diagnose BD/DNC, given these areas are critical to cognition. […] It is of paramount importance to ensure the etiology of brain injury, history, exam, and neuroimaging all are consistent with irreversible catastrophic injury to the whole brain.

• #55 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 1959, the concept of brain death/death by neurologic criteria (BD/DNC) was first theorized as le coma dpass, by Mollaret and Goulon, who described an apneic, comatose patient without brainstem reflexes or electroencephalographic (EEG) activity. […] Neurologists began to postulate that neurologic function was equally or more vital than cardiopulmonary function, and began a process to define death neurologically, independent of other essential organ functions. […] 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.

• #56

  https://journals.lww.com/neur/fulltext/2018/66020/brain_death_revisited.5.aspx

  Most countries agree that the clinical diagnosis of brain stem death is sufficient for certification of death in adults. […] In spite of the existing guidelines, variations and inconsistencies necessitate the requirement for an international consensus to define when a person can be declared brain dead. […] Brain death was first described by two French physicians, Mollart and Goulon and termed 'coma depasse’ (a state beyond coma). […] In 1968, the Ad Hoc Committee of the Harvard Medical School defined brain death as a state of irreversible coma, with the patient being totally unreceptive and unresponsive, with absent reflexes and no spontaneous respiratory effort during a 3-minute period of disconnection from the ventilator. […] However Joseph Verheijde and colleagues argued against the validity of the Harvard criteria for equating brain death with human death.

• #57 ‘Brain death’: should it be reconsidered? | Spinal Cord

  https://www.nature.com/articles/3102107

  To evaluate whether current clinical criteria and confirmatory tests for the diagnosis of brain death satisfy the requirements for the irreversible cessation of all functions of the entire brain including the brainstem. […] We present four arguments to support the view that patients who meet the current operational criteria of brain death do not necessarily have the irreversible loss of all brain (or brainstem) functions. […] The stated definition of brain death (the complete cessation of all functions of the entire brain) is now acknowledged even by supporters of the concept of brain death to be only an approximation. […] The criteria for brain death determination according to the ad hoc Harvard Committee were drawn up by Professor Raymond Adams and included a permanent state of complete unreceptivity and complete unresponsivity, the latter including all responses, whether brainstem, spinal or cerebral in origin.

• #58 What Should We Do When Families Refuse Testing for Brain Death? | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/what-should-we-do-when-families-refuse-testing-brain-death/2020-12

  Brain death was standardized in US law in 1980 with the Uniform Determination of Death Act (UDDA). The UDDA provides 2 pathways for diagnosing biological death: (1) the irreversible loss of cardiorespiratory function (how most people die) or (2) the irreversible loss of all functions of the entire brain (a way of dying that can only happen when patients are being mechanically ventilated in an ICU). Its framers were very careful to state that they were not redefining death. Death was, they insisted, characterized biologically as irreversible loss of integrated functioning of the organism as a whole. Scientifically, death is fundamentally the same across the biological spectrum; we speak of dead animals, dead plants, and dead people. Death is always followed by disintegration and putrefaction. Dust to dust.

• #59 ‘Brain death’: should it be reconsidered? | Spinal Cord

  https://www.nature.com/articles/3102107

  To evaluate whether current clinical criteria and confirmatory tests for the diagnosis of brain death satisfy the requirements for the irreversible cessation of all functions of the entire brain including the brainstem. […] We present four arguments to support the view that patients who meet the current operational criteria of brain death do not necessarily have the irreversible loss of all brain (or brainstem) functions. […] The stated definition of brain death (the complete cessation of all functions of the entire brain) is now acknowledged even by supporters of the concept of brain death to be only an approximation. […] The criteria for brain death determination according to the ad hoc Harvard Committee were drawn up by Professor Raymond Adams and included a permanent state of complete unreceptivity and complete unresponsivity, the latter including all responses, whether brainstem, spinal or cerebral in origin.

• #60 ‘Brain death’: should it be reconsidered? | Spinal Cord

  https://www.nature.com/articles/3102107

  Current criteria for brain death require the complete cessation of all functions of the entire brain, including the brain stem, but do not require cessation of function of the spinal cord. […] Therefore, according to the above arguments, the assumption that all functions of the entire brain (or those of the brainstem) in brain-dead patients diagnosed according to all proposed criteria have ceased, is invalidated. […] Not one of the various confirmatory tests has the necessary positive predictive value (100%), for the pronouncement of human death. […] The conclusion of the above analysis is that somatic survival is feasible, for various periods of time, even in the presence of a totally destroyed brain; therefore, the destruction of the brain cannot be equated with the human death.

• #61 ‘Brain death’: should it be reconsidered? | Spinal Cord

  https://www.nature.com/articles/3102107

  Current criteria for brain death require the complete cessation of all functions of the entire brain, including the brain stem, but do not require cessation of function of the spinal cord. […] Therefore, according to the above arguments, the assumption that all functions of the entire brain (or those of the brainstem) in brain-dead patients diagnosed according to all proposed criteria have ceased, is invalidated. […] Not one of the various confirmatory tests has the necessary positive predictive value (100%), for the pronouncement of human death. […] The conclusion of the above analysis is that somatic survival is feasible, for various periods of time, even in the presence of a totally destroyed brain; therefore, the destruction of the brain cannot be equated with the human death.

• #62 What Should We Do When Families Refuse Testing for Brain Death? | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/what-should-we-do-when-families-refuse-testing-brain-death/2020-12

  Evidence of why this prominently accepted view of death is wrong comes primarily from the work of a pediatric neurologist, Alan Shewmon. Over the years, he has meticulously documented dozens of cases of prolonged biological survival after a diagnosis of brain death. […] As counterintuitive as it might seem, the biological truth is that the body does not need a brain in order to maintain integrated functioning. […] Cases of prolonged biological survival after a diagnosis of brain death happen regularly. Jahi McMath survived for almost 5 years supported with tube feedings, mechanical ventilation, and occasional hospitalization. […] If brain death is not biological death, then what is it? Brain death unquestionably involves an exceedingly severe brain injury. […] Most neurologists believe that brain death represents a state of irreversible apneic unconsciousness. […] If we can respect individual religious beliefs without significant impact on others, I think there is a strong presumption that we should do so. […] Brain death is legal death in our society, and I can understand the logic of simply telling families that this is the law and that they must comply.

• #63 How Educators Can Help Prevent False Brain Death Diagnoses | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/how-educators-can-help-prevent-false-brain-death-diagnoses/2020-12

  Without the safety net of standardized guidelines, false diagnoses of brain death are more likely to occur. […] Over 50 years after a Harvard ad hoc committee first introduced criteria for the determination of brain death in the United States, progress towards the evidence-based practice of brain death determination has made formidable strides, with the aforementioned limitations.

• #64 Brain death – Wikipedia

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

  Brain death is the permanent, irreversible, and complete loss of brain function, which may include cessation of involuntary activity (e.g., breathing) necessary to sustain life. […] Causes include cardiac arrest, myocardial infarction, stroke, and blood clot. […] Brain death is a medicolegal death of a person due to the complete and irreversible loss of all brain functions, including the brain stem. […] The diagnosis of brain death is often required to be highly rigorous, in order to be certain that the condition is irreversible. […] Brain death can sometimes be difficult to differentiate from other medical states such as barbiturate overdose, acute alcohol poisoning, sedative overdose, hypothermia, hypoglycemia, coma, and chronic vegetative states. […] The continuing function of vital organs in the bodies of those diagnosed brain-dead, if mechanical ventilation and other life-support measures are continued, provides optimal opportunities for their transplantation.

• #65 What is Brain Death?

  https://www.donors1.org/families-of-donors/about-organ-and-tissue-donation/what-is-brain-death/

  Most deceased organ donation cases occur after a patient has been declared brain dead. […] Brain death can be caused by a traumatic brain injury, a stroke, or lack of oxygen to the brain because the heart stopped beating. Aneurysm rupture, heart attack, drug overdose, and car accidents are a few things that can cause injury to the brain, resulting in brain death. […] Brain death is the complete and irreversible end to all brain function. It means the brain has stopped working. It is impossible to restore life once the brain has died.

• #66 Brain Death & Donation after Circulatory Death — LifeSource

  https://www.life-source.org/partners/hospitals/brain-death/

  Brain death is the irreversible cessation of all brain activity, including the brain and brain stem. The brain dies from lack of blood/oxygenation. Brain death is death. […] Brain death results from a major injury to the entire brain, such as: Stroke, Head trauma, Anoxia (lack of oxygen to the brain), Central nervous system tumors. […] Brain death is unique: Less than 3-4% of all deaths actually meet brain death criteria and declaration.

• #67

  https://journals.lww.com/amjm/fulltext/2020/16020/pathophysiology_of_brain_stem_death.4.aspx

  Brain stem death (BD) is a pathological process which is characterized by hormonal impairment, hemodynamic imbalance, and a systemic inflammatory response. Knowledge about these changes is important in managing a BD donor. Three main causes of BD include traumatic brain injury (TBI), cerebrovascular injury, and anoxia. […] The American Academy of Neurology defines BD as the irreversible loss of brain and brain stem function, usually caused by major hemorrhage, hypoxia, or metabolic dysregulation. […] High intracranial pressure causes cerebral and brain stem herniation which leads to sympathetic stimulation and dysfunction of the hypothalamo-pituitary axis. […] Ischemia leads to metabolic acidosis which stimulates the releases of cytokines and activates coagulation factors and promotes leukocytic proliferation, causing systemic inflammatory pathway activation and tissue damage.

• #68

  https://journals.lww.com/amjm/fulltext/2020/16020/pathophysiology_of_brain_stem_death.4.aspx

  BD causes cessation of the hypothalamic-pituitary axis and affects hormone regulation. […] Rapid depletion of ADH causes diabetes insipidus (DI) in 80% of BD donors. […] The biological processes related with transcription (such as regulation of transcription, DNA dependent, and positive regulation of transcription) and metabolic process (such as regulation of phosphate metabolic process and regulation of phosphorus metabolic process) were dysregulated in the liver after BD. […] Newer studies showed that the association between resistin and MCP-1 in the brain stem dead organ donors seems to indicate a causative relationship between these two and may suggest a role for resistin in the initiation of the inflammatory response after brain death. […] The increase in resistin levels reflects the inflammatory state after BD.

• #69

  https://link.springer.com/article/10.1007/s44202-024-00183-w

  Receiving a diagnosis of brain stem death poses significant challenges for families. […] The review underscores the pervasive lack of understanding among families regarding the diagnosis and process of brain stem death, as well as the short- and long-term distress it can engender. […] Despite the first definition of brain stem death (BSD) being identified in 1968 by the Harvard Medical School, there still is not a universally shared concept or recognition accepted. General understanding of BSD is the permanent and total loss of all brain function in the brainstem and cerebrum when oxygen or blood supply to the brain is stopped. […] Prior to testing for BSD, proof is required to confirm that there is irreversible structural brain damage, and that all possibility of a reversible cause of coma can be excluded.

• #70

  https://link.springer.com/article/10.1007/s44202-024-00183-w

  Countries will utilize not only different tests, but they also require these tests to be conducted by different professionals with varying expertise. […] Families experienced a lack of preparedness for BSD and experienced difficulties with the suddenness in which they received news of their family members imminent or confirmed BSD diagnosis. […] Siminoff et al. found, out of the 403 family members informed of the brain stem death diagnosis, only 28.3% could provide an accurate explanation of the diagnosis and 4.5% provided an entirely inaccurate explanation. […] For many, it was difficult to differentiate between BSD and states like a coma, despite being given verbal explanations and documents. […] An understanding of BSD did not stop the families hope for survival, even if they knew it was not possible.

• #71

  https://link.springer.com/article/10.1007/s44202-024-00183-w

  Countries will utilize not only different tests, but they also require these tests to be conducted by different professionals with varying expertise. […] Families experienced a lack of preparedness for BSD and experienced difficulties with the suddenness in which they received news of their family members imminent or confirmed BSD diagnosis. […] Siminoff et al. found, out of the 403 family members informed of the brain stem death diagnosis, only 28.3% could provide an accurate explanation of the diagnosis and 4.5% provided an entirely inaccurate explanation. […] For many, it was difficult to differentiate between BSD and states like a coma, despite being given verbal explanations and documents. […] An understanding of BSD did not stop the families hope for survival, even if they knew it was not possible.

• #72

  https://link.springer.com/article/10.1007/s44202-024-00183-w

  Countries will utilize not only different tests, but they also require these tests to be conducted by different professionals with varying expertise. […] Families experienced a lack of preparedness for BSD and experienced difficulties with the suddenness in which they received news of their family members imminent or confirmed BSD diagnosis. […] Siminoff et al. found, out of the 403 family members informed of the brain stem death diagnosis, only 28.3% could provide an accurate explanation of the diagnosis and 4.5% provided an entirely inaccurate explanation. […] For many, it was difficult to differentiate between BSD and states like a coma, despite being given verbal explanations and documents. […] An understanding of BSD did not stop the families hope for survival, even if they knew it was not possible.

• #73

  https://link.springer.com/article/10.1007/s44202-024-00183-w

  Countries will utilize not only different tests, but they also require these tests to be conducted by different professionals with varying expertise. […] Families experienced a lack of preparedness for BSD and experienced difficulties with the suddenness in which they received news of their family members imminent or confirmed BSD diagnosis. […] Siminoff et al. found, out of the 403 family members informed of the brain stem death diagnosis, only 28.3% could provide an accurate explanation of the diagnosis and 4.5% provided an entirely inaccurate explanation. […] For many, it was difficult to differentiate between BSD and states like a coma, despite being given verbal explanations and documents. […] An understanding of BSD did not stop the families hope for survival, even if they knew it was not possible.

• #74

  https://link.springer.com/article/10.1007/s44202-024-00183-w

  The legal time of death appeared to be confusing for many families, particular the distinction between when the person died and when the body died and how this was communicated by the clinicians. […] The narrative synthesis highlighted five key common themes across the included studies: The unexpected prognosis, coming to terms with brain death-grieving process, observation of brain stem death testing, impact of staff on families experience and the lasting impact. […] One of the main findings is that families often do not understand the concept of BSD, what the diagnosis is, and what the implications are. […] A lack of communication and input from staff forces families to have to work out the answers for themselves and considering the wide range of debate surrounding BSD online, time in the ICU with expert professionals presents an opportunity for clarification that families may not receive elsewhere.

• #75

  https://link.springer.com/article/10.1007/s44202-024-00183-w

  The findings highlight the importance of staff input on families experience and understanding of BSD and need for better family support provision and training for clinical staff. […] Religion and spirituality are likely to play a role in this experience of holding on to hope vs acceptance. […] The allowed time for acceptance and understanding of the diagnosis is referred to in BSD literature. […] Some participants described BSD as a suspended death describing a discrepancy between what they felt was the time of death and the medicolegal death which they claimed interfered with their grieving process. […] It is important to consider the idea of ambiguous loss when thinking about BSD, the family member appearing warm and breathing when told their life is permanently lost. […] The review highlights the psychological impact of a relative’s diagnosis of brain stem death (BSD) on families. Specifically, it underscores the families’ persistent lack of understanding of the diagnosis, even months after their relative has passed, and the longer-term psychological distress they endure.

• #76

  https://journals.lww.com/neur/fulltext/2018/66020/brain_death_revisited.5.aspx

  The DDR (Dead Donor Rule) is the formalization of the widely held belief that it is wrong to kill one person to save the life of another, leading to the conclusion that people should already be dead before vital organs are removed, an act that would certainly kill them. […] The process implies that once a person is brain dead, it is unethical to continue treatment. […] In India, there is no legal definition of death. […] Medically and legally, the patient is dead, if brain stem death (brain death is used as a synonym for the latter) has been certified. […] The declaration of brain death must be recorded in the medical notes with the date and time. […] Once an unequivocal diagnosis of brain death has been made, most medical and legal authorities agree that continuing treatment is not in the interest of the patient or is ethically permissible. […] Brain death has created a new class of dead people that does not conform to the society’s expectations of normal death and dying.

• #77

  https://link.springer.com/article/10.1007/s44202-024-00183-w

  The findings highlight the importance of staff input on families experience and understanding of BSD and need for better family support provision and training for clinical staff. […] Religion and spirituality are likely to play a role in this experience of holding on to hope vs acceptance. […] The allowed time for acceptance and understanding of the diagnosis is referred to in BSD literature. […] Some participants described BSD as a suspended death describing a discrepancy between what they felt was the time of death and the medicolegal death which they claimed interfered with their grieving process. […] It is important to consider the idea of ambiguous loss when thinking about BSD, the family member appearing warm and breathing when told their life is permanently lost. […] The review highlights the psychological impact of a relative’s diagnosis of brain stem death (BSD) on families. Specifically, it underscores the families’ persistent lack of understanding of the diagnosis, even months after their relative has passed, and the longer-term psychological distress they endure.

• #78

  https://link.springer.com/article/10.1007/s44202-024-00183-w

  The findings highlight the importance of staff input on families experience and understanding of BSD and need for better family support provision and training for clinical staff. […] Religion and spirituality are likely to play a role in this experience of holding on to hope vs acceptance. […] The allowed time for acceptance and understanding of the diagnosis is referred to in BSD literature. […] Some participants described BSD as a suspended death describing a discrepancy between what they felt was the time of death and the medicolegal death which they claimed interfered with their grieving process. […] It is important to consider the idea of ambiguous loss when thinking about BSD, the family member appearing warm and breathing when told their life is permanently lost. […] The review highlights the psychological impact of a relative’s diagnosis of brain stem death (BSD) on families. Specifically, it underscores the families’ persistent lack of understanding of the diagnosis, even months after their relative has passed, and the longer-term psychological distress they endure.

• #79

  https://link.springer.com/article/10.1007/s44202-024-00183-w

  The findings highlight the importance of staff input on families experience and understanding of BSD and need for better family support provision and training for clinical staff. […] Religion and spirituality are likely to play a role in this experience of holding on to hope vs acceptance. […] The allowed time for acceptance and understanding of the diagnosis is referred to in BSD literature. […] Some participants described BSD as a suspended death describing a discrepancy between what they felt was the time of death and the medicolegal death which they claimed interfered with their grieving process. […] It is important to consider the idea of ambiguous loss when thinking about BSD, the family member appearing warm and breathing when told their life is permanently lost. […] The review highlights the psychological impact of a relative’s diagnosis of brain stem death (BSD) on families. Specifically, it underscores the families’ persistent lack of understanding of the diagnosis, even months after their relative has passed, and the longer-term psychological distress they endure.

• #80

  https://link.springer.com/article/10.1007/s44202-024-00183-w

  The findings highlight the importance of staff input on families experience and understanding of BSD and need for better family support provision and training for clinical staff. […] Religion and spirituality are likely to play a role in this experience of holding on to hope vs acceptance. […] The allowed time for acceptance and understanding of the diagnosis is referred to in BSD literature. […] Some participants described BSD as a suspended death describing a discrepancy between what they felt was the time of death and the medicolegal death which they claimed interfered with their grieving process. […] It is important to consider the idea of ambiguous loss when thinking about BSD, the family member appearing warm and breathing when told their life is permanently lost. […] The review highlights the psychological impact of a relative’s diagnosis of brain stem death (BSD) on families. Specifically, it underscores the families’ persistent lack of understanding of the diagnosis, even months after their relative has passed, and the longer-term psychological distress they endure.

• #81 Death – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/death/

  Brainstem areflexia: Absence of pupillary light reflex: nonreactive, midsized, or dilated pupils. […] Apnea testing: An essential part of the evaluation of brain death, proving the absence of brainstem respiratory control system reflexes. […] If a patient has been declared to have brain death, no consent is needed to withdraw life-sustaining therapy. […] If the patient’s family disagrees with a diagnosis of brain death: Discuss the family members’ concerns with them; express empathy and respect for their position and provide additional information to eliminate any misunderstandings regarding the diagnosis.

• #82

  https://link.springer.com/article/10.1007/s44202-024-00183-w

  The findings highlight the importance of staff input on families experience and understanding of BSD and need for better family support provision and training for clinical staff. […] Religion and spirituality are likely to play a role in this experience of holding on to hope vs acceptance. […] The allowed time for acceptance and understanding of the diagnosis is referred to in BSD literature. […] Some participants described BSD as a suspended death describing a discrepancy between what they felt was the time of death and the medicolegal death which they claimed interfered with their grieving process. […] It is important to consider the idea of ambiguous loss when thinking about BSD, the family member appearing warm and breathing when told their life is permanently lost. […] The review highlights the psychological impact of a relative’s diagnosis of brain stem death (BSD) on families. Specifically, it underscores the families’ persistent lack of understanding of the diagnosis, even months after their relative has passed, and the longer-term psychological distress they endure.

• #83 Brain Death – EMCrit Project

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

  Defined as irreversible cessation of all cerebral and brainstem functioning. […] Brain death is legally recognized as equivalent to cardiopulmonary death in the United States. […] Brain death is defined by a strict set of criteria that, once met, confers zero likelihood of awakening from coma. […] Regardless of the initial injury, eventually brain death occurs via a spiral of progressive intracranial hypertension, tissue damage, and edema. This is essentially an intracranial compartment syndrome. […] Complete brain death occurs when there is complete circulatory arrest of the brain no blood is entering the brain. […] Common causes of brain death (if present, these support the diagnosis of brain death) include traumatic brain injury, intracranial hemorrhage, anoxic brain injury (usually due to cardiopulmonary arrest), fulminant meningitis or encephalitis, fulminant hepatic failure causing cerebral edema, and ischemic stroke with cerebral edema and herniation. […] Brain death evaluation is a standard component of medical care. […] Once the patient has been declared brain dead they are deceased (brain dead is dead).

• #84 Brain death | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/brain-death-2?lang=us

  Brain death (or death by neurological criteria) refers to the irreversible end of all brain activity and is usually assessed clinically. […] As the diagnosis of brain death is considered equivalent to cardiac death in many jurisdictions and it allows organ donation for transplantation or withdrawal of life support, most countries have specific and varied related legal standards and practice guidelines. […] It should be noted that brain death imaging is not synonymous with identifying extensive global hypoxic-ischemic injury. […] Furthermore, it is essential to realize that the absence of brain perfusion implies brain death, but the converse is not true. […] In situations where intracranial pressure is not sufficiently elevated, perfusion can continue to occur even though there may be profound global brain infarction.

• #85 What Should We Do When Families Refuse Testing for Brain Death? | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/what-should-we-do-when-families-refuse-testing-brain-death/2020-12

  Brain death was standardized in US law in 1980 with the Uniform Determination of Death Act (UDDA). The UDDA provides 2 pathways for diagnosing biological death: (1) the irreversible loss of cardiorespiratory function (how most people die) or (2) the irreversible loss of all functions of the entire brain (a way of dying that can only happen when patients are being mechanically ventilated in an ICU). Its framers were very careful to state that they were not redefining death. Death was, they insisted, characterized biologically as irreversible loss of integrated functioning of the organism as a whole. Scientifically, death is fundamentally the same across the biological spectrum; we speak of dead animals, dead plants, and dead people. Death is always followed by disintegration and putrefaction. Dust to dust.

• #86

  https://journals.lww.com/neur/fulltext/2018/66020/brain_death_revisited.5.aspx

  The DDR (Dead Donor Rule) is the formalization of the widely held belief that it is wrong to kill one person to save the life of another, leading to the conclusion that people should already be dead before vital organs are removed, an act that would certainly kill them. […] The process implies that once a person is brain dead, it is unethical to continue treatment. […] In India, there is no legal definition of death. […] Medically and legally, the patient is dead, if brain stem death (brain death is used as a synonym for the latter) has been certified. […] The declaration of brain death must be recorded in the medical notes with the date and time. […] Once an unequivocal diagnosis of brain death has been made, most medical and legal authorities agree that continuing treatment is not in the interest of the patient or is ethically permissible. […] Brain death has created a new class of dead people that does not conform to the society’s expectations of normal death and dying.

• #87 Death – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/death/

  Brainstem areflexia: Absence of pupillary light reflex: nonreactive, midsized, or dilated pupils. […] Apnea testing: An essential part of the evaluation of brain death, proving the absence of brainstem respiratory control system reflexes. […] If a patient has been declared to have brain death, no consent is needed to withdraw life-sustaining therapy. […] If the patient’s family disagrees with a diagnosis of brain death: Discuss the family members’ concerns with them; express empathy and respect for their position and provide additional information to eliminate any misunderstandings regarding the diagnosis.

• #88

  https://journals.lww.com/neur/fulltext/2018/66020/brain_death_revisited.5.aspx

  The DDR (Dead Donor Rule) is the formalization of the widely held belief that it is wrong to kill one person to save the life of another, leading to the conclusion that people should already be dead before vital organs are removed, an act that would certainly kill them. […] The process implies that once a person is brain dead, it is unethical to continue treatment. […] In India, there is no legal definition of death. […] Medically and legally, the patient is dead, if brain stem death (brain death is used as a synonym for the latter) has been certified. […] The declaration of brain death must be recorded in the medical notes with the date and time. […] Once an unequivocal diagnosis of brain death has been made, most medical and legal authorities agree that continuing treatment is not in the interest of the patient or is ethically permissible. […] Brain death has created a new class of dead people that does not conform to the society’s expectations of normal death and dying.

• #89

  https://journals.lww.com/neur/fulltext/2018/66020/brain_death_revisited.5.aspx

  The DDR (Dead Donor Rule) is the formalization of the widely held belief that it is wrong to kill one person to save the life of another, leading to the conclusion that people should already be dead before vital organs are removed, an act that would certainly kill them. […] The process implies that once a person is brain dead, it is unethical to continue treatment. […] In India, there is no legal definition of death. […] Medically and legally, the patient is dead, if brain stem death (brain death is used as a synonym for the latter) has been certified. […] The declaration of brain death must be recorded in the medical notes with the date and time. […] Once an unequivocal diagnosis of brain death has been made, most medical and legal authorities agree that continuing treatment is not in the interest of the patient or is ethically permissible. […] Brain death has created a new class of dead people that does not conform to the society’s expectations of normal death and dying.

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