Materiały źródłowe

• #1 The diagnosis of brain death

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

  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. A patient determined to be brain dead is legally and clinically dead. […] 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. […] 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.

• #1 Brain Death: What It Is, Stages & Criteria

  https://my.clevelandclinic.org/health/diseases/brain-death

  Brain death is when a medical condition like a stroke or a traumatic brain injury causes major and permanent damage to your brain. In brain death, you’re unconscious and you can’t breathe on your own. Healthcare providers follow medical criteria (guidelines) before diagnosing brain death. They perform specific tests before making a final diagnosis. […] Brain death is the medical and legal term for death that happens when your brain stops working. In brain death, injury or illness does severe, permanent damage to your entire brain and brainstem. Your brainstem manages your breathing and heart rate. Your brain manages senses like sight, sound and touch, and abilities like motor movement. […] Because people’s brains drive these essential functions, someone is legally dead when they’re diagnosed with brain death. Healthcare providers follow established medical criteria (guidelines) to determine if someone is brain dead.

• #1

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

  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. […] But they will not ever regain consciousness or start breathing on their own again. They have already died. […] After brain death, it is not possible for someone to remain conscious. […] Brain death can happen when the blood or oxygen supply to the brain is stopped. […] Brain death is permanent.

• #1 Brain Death – EMCrit Project

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

  Defined as irreversible cessation of all cerebral and brainstem functioning. […] 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. […] Clinical context may either support the possibility of brain death, or it may suggest the possibility of a brain-death mimic. […] Cardinal findings include coma, no cranial nerve function, and no respiratory drive. […] Patient is not chemically paralyzed (e.g., deep tendon reflexes are preserved). […] Brain death leads to the disinhibition of spinal cord reflexes (which are normally suppressed). […] The most classic spinal reflex is triple flexion, wherein stimulation of the feet causes flexion at the ankles, knees, and hips.

• #1 Brain Death – StatPearls – NCBI Bookshelf

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

  Brain death, both a legal and clinical term, has been present in medical literature and texts for many years and was defined by the Uniform Determination of Death Act (UDDA) in 1981. […] 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%. […] The physiology of brain death is similar regardless of the etiology. Inadequate tissue oxygenation leads to a progressive cascade of further edema, increasing intracranial pressure (ICP), a further decrease in cerebral perfusion and eventual herniation, or complete cessation of blood flow and aseptic necrosis of brain tissue. […] The prognosis of brain death, by definition, is 100% fatal.

• #1 Cerebral hypoxia: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/001435.htm

  Symptoms of severe cerebral hypoxia include: […] Complete unawareness and unresponsiveness (coma) […] No breathing […] No response of the pupils of the eye to light. […] Brain cells are very sensitive to a lack of oxygen. Some brain cells start dying less than 5 minutes after their oxygen supply disappears. As a result, brain hypoxia can rapidly cause severe brain damage or death. […] If only blood pressure and heart function remain, the brain may be completely dead. […] The longer a person is unconscious, the higher the risk for death or brain death, and the lower the chances of recovery. […] Complications of cerebral hypoxia include a prolonged vegetative state. This means the person may have basic life functions, such as breathing, blood pressure, sleep-wake cycle, and eye opening, but the person is not alert and does not respond to their surroundings. Such people usually die within a year, although some may survive longer.

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

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

  The pathophysiology of brain death is analogous irrespective of the cause. Tissue hypoxia leads to a continuous gush of excess edema (due to liberation of cytotoxic materials), elevated intracranial pressure (which in turn impairs more the brain tissue oxygenation), marked reduction of cerebral perfusion and brain herniation, or complete stop of cerebral blood flow and a subsequent brain tissue aseptic necrosis. […] Clinical evaluation and diagnosis of brain death must be completed as follows: (1) confirmation of the etiology; (2) Exclusion of all reversible conditions that may simulate brain death. and, (3) identification of clinical hallmarks of brain death namely coma, absence of brainstem reflexes, and complete cessation of spontaneous breathing (apnea). […] Apnea testing is based upon the functional ability of the chemoreceptors located in the medulla to provoke spontaneous respiratory acts in response to acidosis and hypercarbia. However, the exact CO2 and pH levels that are presumed to initiate receptor stimulation are still unknown. […] When brain death has been established, the patient is legally and clinically declared as dead at the time of decease after testing.

• #1 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. […] Some of the signs of brain death include: The pupils dont respond to light. The person shows no reaction to pain. The eyes dont blink when the eye surface is touched (corneal reflex). The eyes dont move when the head is moved (oculocephalic reflex). The eyes dont move when ice water is poured into the ear (oculo-vestibular reflex). There is no gagging reflex when the back of the throat is touched. The person doesnt breathe when the ventilator is switched off. An electroencephalogram test shows no brain activity at all. […] Brain death means the person has died. […] It is important for the medical staff members to fully explain that brain death is final, and that the person is dead and has no chance of ever regaining consciousness again. […] In some cases, a person who is brain dead may be a candidate for organ donation.

• #1 Brain Death: What It Is, Stages & Criteria

  https://my.clevelandclinic.org/health/diseases/brain-death

  In brain death, you don’t react to noise, lights or touch as you would before your brain injury. You may move, but your movement is involuntary, meaning you didn’t move on purpose. […] If you have a catastrophic brain injury, you can’t breathe on your own and rely on mechanical ventilation (ventilators). In an apnea test, providers briefly stop ventilator support to see if you take a breath on your own. […] First, your healthcare providers will share and explain test results with your family, including that a brain death diagnosis means death. […] No, people don’t recover from brain death. Healthcare providers follow strict guidelines about assessing and testing for potential brain death. If tests indicate brain death, the person is clinically dead. […] No, you can’t because you may not be able to prevent any of the serious illnesses or injuries that lead to brain death. In some cases, immediate medical care may keep brain death from happening if you have a serious illness or an injury that affects your brain. But once your brain stops working, there isn’t a treatment that can prevent brain death from happening.

• #1 The diagnosis of brain death

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

  The apnoea test need only be performed once when its results are conclusive. […] If respiratory movements are absent and arterial PCO2 is 60 mm Hg (option: 20 mm Hg increase in PCO2 over a baseline normal PCO2), the apnoea test result is positive (i.e. it supports the diagnosis of brain death). […] The following manifestations are occasionally seen and should not be misinterpreted as evidence for brainstem function: spontaneous movements of limbs other than pathologic flexion or extension response, respiratory-like movements, sweating, flushing, tachycardia, normal blood pressure without pharmacologic support or sudden increases in blood pressure, absence of diabetes insipidus, deep tendon reflexes; superficial abdominal reflexes; triple flexion response, Babinski reflex. […] The examination as described above should be repeated in full and documented. When clinical circumstances prohibit completion of any steps in the clinical examination, these should be documented. […] When the full clinical examination, including both assessments of brain stem reflexes and the apnoea test, is conclusively performed, no additional testing is required to determine brain death.

• #1 Brain death – Wikipedia

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

  The diagnosis of brain death is often required to be highly rigorous, in order to be certain that the condition is irreversible. Legal criteria vary, but in general require neurological examinations by two independent physicians. The exams must show complete and irreversible absence of brain function (brain stem function in UK), and may include two isoelectric (flat-line) EEGs 24 hours apart.

• #1 Facts about brain death and how it’s determined – Gift of Life Michigan

  https://giftoflifemichigan.org/blog/facts-about-brain-death-and-how-its-determined

  Brain death is death. […] Brain death is the irreversible and complete loss of brain and brain stem function. […] Brain death typically occurs after a major injury or illness where the blood supply to the brain is blocked, or the brain begins to swell within the skull. […] These traumatic events cause the brain to lose oxygen or begin to swell beyond recovery. […] Brain death is not the same as a coma or a prolonged vegetative state. […] Brain death is determined by strict medical and legal criteria. […] A patient must undergo extensive testing and verifications before they are declared brain dead by a physician. […] In brain death, patients dont react to noise, lights or touch as they would before a brain injury. […] If the patient has a catastrophic brain injury, they cant breathe on their own and rely on ventilators.

• #1 Clinico-radiological related to early brain death factors | Medicina Intensiva

  https://www.medintensiva.org/en-clinico-radiological-related-early-brain-death-articulo-S217357272100148X

  To identify clinical and radiological factors associated to early evolution to brain death (BD), defined as occurring within the first 24h. […] Early BD (24h) was associated to GCS5, midline shift, effacement of the basal cisterns, cerebral sulci and suprasellar cistern, and ependymal transudation. […] Patients with endocranial hypertension progress into brain death (BD) when intracranial pressure (ICP) exceeds the systolic arterial pressure, thus leading to cerebral circulatory arrest, being the intracerebral hemorrhage (ICH) the most common etiology in Spain followed by traumatic brain injury (TBI), and subarachnoid hemorrhage (SAH). […] We know that most patients with severe brain injuries who progress into BD do so within the first 72h. […] Several studies have identified clinical and radiological signs predictive of progression into BD.

• #1

  https://viasonix.com/neurology-neurosurgery/brain-death/

  Brain Death, or Cerebral Circulatory Arrest, is the irreversible complete loss of brain function. This condition of brain damage is characterized by almost no volume blood flow to the brain and very high distal resistance to arterial flow. […] Transcranial Doppler (TCD) can help detect the different progression stages of cerebral circulatory arrest towards complete brain death. Distal resistance to flow increases sharply and TCD can serve as an ancillary modality for the detection and confirmation of brain death in addition to other modalities for brain death determination. […] A suspected cerebral circulatory arrest appears in various forms in the Doppler spectrum as the condition progresses. Measurements must be performed for both the anterior and posterior circulations. The various stages may include:

• #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. […] A brain-dead individual has no clinical evidence of brain function upon physical examination. This includes no response to pain and no cranial nerve reflexes. Reflexes include pupillary response (fixed pupils), oculocephalic reflex, corneal reflex, no response to the caloric reflex test, and no spontaneous respirations. […] 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. Some comatose patients can recover to pre-coma or near pre-coma level of functioning, and some patients with severe irreversible neurological dysfunction will nonetheless retain some lower brain functions, such as spontaneous respiration, despite the losses of both cortex and brain stem functionality.

• #1 Quick Facts:Brain Death – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/quick-facts-brain-spinal-cord-and-nerve-disorders/coma-and-impaired-consciousness/brain-death

  Brain death is when a person’s brain has completely stopped working but the body is being kept alive by breathing machines and medicines. […] People who are brain dead are unaware and can’t think or feel. They can’t move or breathe. Their brain stops controlling automatic body functions such as heartbeat and blood pressure. People with brain death are considered legally dead. […] No one who’s brain dead ever recovers. Brain death is different from coma. People in a coma have some brain function and sometimes recover. […] If there’s no sign of brain activity, doctors sometimes test again 6 to 24 hours later to make sure the person again shows no response. After testing twice with no response, doctors know that the person is brain dead. […] People with no electrical activity or blood flow in the brain have brain death. But these tests aren’t required.

• #1

  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. […] After brain death, it’s not possible for someone to remain conscious. […] Brain death can happen when the blood and/or oxygen supply to the brain is stopped. […] Brain death is different from vegetative state. […] The difference between brain death and a vegetative state (a disorder of consciousness), which can happen after extensive brain damage, is that it’s possible to recover from a vegetative state, but brain death is permanent.

• #1 Brain death diagnosis | STROKE MANUAL

  https://www.stroke-manual.com/brain-death-diagnosis/

  absence of abnormal postural responses, such as decorticate or decerebrate posturing, evoked by painful stimuli […] absence of spontaneous eye movements or abnormal eye position […] non-reactive moderately dilated or mydriatic pupils […] repeated tests show the irreversibility of the clinical condition […] when the accurate evaluation of a component of the BD/DNC neurologic examination cannot be assessed safely, clinicians must perform ancillary testing to complete the BD/DNC determination […] there must be no doubt about the cause of BD/DNC and the irreversibility of brain damage […] exclude all potentially reversible causes […] severe hypotension maintain SBP 100 mm Hg and mean arterial pressure (MAP) 75 mm Hg […] neuroendocrine function can persist in patients with permanent injury to the brain and is not inconsistent with the whole brain standard of death

• #1

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

  The following conditions may interfere with the clinical diagnosis of brain death. Confirmatory tests are recommended. […] The apnea test is essential for confirmation of brain stem death. […] If the apnea test cannot be safely completed, an ancillary study should be performed. […] 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. […] Total loss of neurophysiological functions of the brain for more than 8 minutes confirms total and irreversible loss of brain function. […] Even with maximal support, cardio-respiratory deterioration leading to somatic death will occur within days, although persistence of the cardio-respiratory drive for prolonged periods, even over 100 days, has been reported.

• #1 Brain Death – Neurologic Disorders – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/neurologic-disorders/coma-and-impaired-consciousness/brain-death

  Brain death, also known as brain death/death by neurologic criteria, refers to a permanent loss of brain function that cannot resume spontaneously and cannot be restored by medical interventions. Function of the entire cerebrum and brain stem is lost, resulting in coma, no spontaneous respiration, and loss of all brain stem reflexes. Spinal reflexes, including deep tendon, plantar flexion, and withdrawal reflexes, may remain. […] The diagnosis of brain death is equivalent to the persons death. No further treatment can prevent death. […] After brain death is confirmed, all supporting cardiac and respiratory treatments are ended. Cessation of ventilatory support results in terminal arrhythmias. Spinal motor reflexes may occur during terminal apnea; they include arching of the back, neck turning, stiffening of the legs, and upper extremity flexion (the so-called Lazarus sign). Family members who wish to be present when the ventilator is shut off need to be warned of such reflex movements.

• #1 Confronting the Signs of Brain Death

  https://www.brainandlife.org/articles/confronting-brain-death

  Understanding the criteria for brain death is key to helping doctors and families make appropriate and consistent decisions. […] Once brain death has occurred, the person known and loved by friends and family is gone. […] Declaring someone brain dead is not subjective or arbitrary, because brain death is a clinical, measurable condition. […] The guideline also provides neurologists with a checklist that they can take to the bedside to make sure that the determination is made with the utmost precision. […] But we decided to take the risk because of the immense need for organs and because understanding what brain death is helps people make a more informed decision about organ donation. […] As a neurologist, I have the utmost confidence that brain death can be determined precisely and objectively.

• #2 Brain Death | National Kidney Foundation

  https://www.kidney.org/kidney-topics/brain-death

  Brain death is the complete and irreversible loss of all brain function. It is diagnosed through clinical tests and confirmed by medical guidelines. […] The diagnosis of brain death is defined as „death based on the absence of all neurologic function.” […] Brain death is a legal definition of death. It is the complete stopping of all brain function and cannot be reversed. It means that, because of extreme and serious trauma or injury to the brain, the body’s blood supply to the brain is blocked, and the brain dies. Brain death is death. It is permanent. […] A doctor will do tests to make a diagnosis of brain death. These tests are based on sound and legally accepted medical guidelines. Tests include a clinical examination to show that an individual has no brain reflexes and cannot breathe on his or her own.

• #2

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

  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. […] But they will not ever regain consciousness or start breathing on their own again. They have already died. […] After brain death, it is not possible for someone to remain conscious. […] Brain death can happen when the blood or oxygen supply to the brain is stopped. […] Brain death is permanent.

• #2 Brain stem death | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/brain-nerves-and-spinal-cord/brain-stem-death/

  Brain stem death is when a person no longer has any brain stem function. When someone loses their brain stem function permanently, medical professionals will confirm theyre dead. […] Once the brain stem has stopped functioning, theres no way of reversing it. The person will not be able to regain consciousness or recover. […] Even if someone is on a ventilator, theres no way of reversing brain stem death. Their heart will eventually stop beating. […] Brain death can occur 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, stroke when the blood supply to the brain is blocked or interrupted, a severe head injury, a brain haemorrhage, infections, like encephalitis or meningitis.

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

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

  The pathophysiology of brain death is analogous irrespective of the cause. Tissue hypoxia leads to a continuous gush of excess edema (due to liberation of cytotoxic materials), elevated intracranial pressure (which in turn impairs more the brain tissue oxygenation), marked reduction of cerebral perfusion and brain herniation, or complete stop of cerebral blood flow and a subsequent brain tissue aseptic necrosis. […] Clinical evaluation and diagnosis of brain death must be completed as follows: (1) confirmation of the etiology; (2) Exclusion of all reversible conditions that may simulate brain death. and, (3) identification of clinical hallmarks of brain death namely coma, absence of brainstem reflexes, and complete cessation of spontaneous breathing (apnea). […] Apnea testing is based upon the functional ability of the chemoreceptors located in the medulla to provoke spontaneous respiratory acts in response to acidosis and hypercarbia. However, the exact CO2 and pH levels that are presumed to initiate receptor stimulation are still unknown. […] When brain death has been established, the patient is legally and clinically declared as dead at the time of decease after testing.

• #2 What You Need to Know About Brain Oxygen Deprivation

  https://www.spinalcord.com/blog/what-happens-after-a-lack-of-oxygen-to-the-brain

  At the one-minute mark, brain cells begin dying. […] At three minutes, neurons suffer more extensive damage, and lasting brain damage becomes more likely. […] At five minutes, death becomes imminent. […] At 10 minutes, even if the brain remains alive, a coma and lasting brain damage are almost inevitable. […] At 15 minutes, survival becomes nearly impossible. […] When your brain is deprived of oxygen, then, the ultimate cause of brain death is inadequate energy to power the brain’s cells. […] Common long-term effects of oxygen deprivation can include dementia-like symptoms, including confusion, memory difficulties, and signs of rapid brain aging.

• #2 Brain Death – MD Searchlight

  https://mdsearchlight.com/health/brain-death/

  Brain death is most commonly caused by four things: cardiopulmonary arrest, traumatic brain injury (TBI), subarachnoid hemorrhage, and intracerebral hemorrhage, listed here in order of how often they happen. When someone has a heart or lung failure (cardiopulmonary arrest), there is a 8.9% chance that they could become brain dead after they are revived. Those with TBI, the chance of becoming brain dead is between 2.8% to 6.1%. […] Simply put, brain death means the brain has stopped working and won’t start again. This condition, unfortunately, is always fatal, meaning that once someone is declared brain dead, recovery is not possible.

• #2 Brain death diagnosis | STROKE MANUAL

  https://www.stroke-manual.com/brain-death-diagnosis/

  brain death (BD)/death by neurologic criteria (DNC) is defined as the permanent (irreversible) loss of all functions of the entire brain (including the brainstem), regardless of the continued function of the cardiovascular system and other organs […] loss of all functions results in coma, brainstem areflexia, and apnea in the setting of an adequate stimulus […] patients with any evidence of consciousness or preservation of any brainstem reflex or who display motor movements that are mediated by the brain or brainstem or are spontaneously breathing do not meet established criteria and must not undergo BD/DNC testing […] the following items are usually part of the clinical brain death protocol and should ALL be negative: brainstem reflexes […] cessation of brainstem reflexes […] respiratory arrest positive apnea test

• #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. A person who is brain dead may still show signs of life such as warm skin, a heartbeat, and a chest that rises and falls with ventilation. Even though a brain-dead person may appear to be alive, the brain is significantly damaged and recovery is impossible. […] Lack of response to stimuli is one of the criteria healthcare providers use when declaring someone brain dead. Some of the other criteria include an absence of reflexes and an inability to breathe without a ventilator. […] Before brain death is pronounced, three clinical criteria must be met: Unresponsiveness, Absence of reflexes, and Apnea. […] A person who is brain-dead will not have any brainstem reflexes. […] When a person is brain dead, the brain is unable to send the signal to breathe and breathing does not happen without the support of a ventilator.

• #2 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. […] A brain-dead individual has no clinical evidence of brain function upon physical examination. This includes no response to pain and no cranial nerve reflexes. Reflexes include pupillary response (fixed pupils), oculocephalic reflex, corneal reflex, no response to the caloric reflex test, and no spontaneous respirations. […] 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. Some comatose patients can recover to pre-coma or near pre-coma level of functioning, and some patients with severe irreversible neurological dysfunction will nonetheless retain some lower brain functions, such as spontaneous respiration, despite the losses of both cortex and brain stem functionality.

• #2 The diagnosis of brain death

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

  The apnoea test need only be performed once when its results are conclusive. […] If respiratory movements are absent and arterial PCO2 is 60 mm Hg (option: 20 mm Hg increase in PCO2 over a baseline normal PCO2), the apnoea test result is positive (i.e. it supports the diagnosis of brain death). […] The following manifestations are occasionally seen and should not be misinterpreted as evidence for brainstem function: spontaneous movements of limbs other than pathologic flexion or extension response, respiratory-like movements, sweating, flushing, tachycardia, normal blood pressure without pharmacologic support or sudden increases in blood pressure, absence of diabetes insipidus, deep tendon reflexes; superficial abdominal reflexes; triple flexion response, Babinski reflex. […] The examination as described above should be repeated in full and documented. When clinical circumstances prohibit completion of any steps in the clinical examination, these should be documented. […] When the full clinical examination, including both assessments of brain stem reflexes and the apnoea test, is conclusively performed, no additional testing is required to determine brain death.

• #2 Brain Death – EMCrit Project

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

  If at any point the patient shows evidence of cerebral activity, then brain death is excluded. […] If there is any respiratory effort then the patient isn’t brain dead. […] In brain death, lack of brain perfusion causes an empty skull sign. […] Myocardial stunning and systolic heart failure are common following brain death. […] Brain death may lead to spontaneous development of hypothermia.

• #2 Brain Death – Neurologic Disorders – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/neurologic-disorders/coma-and-impaired-consciousness/brain-death

  Brain death, also known as brain death/death by neurologic criteria, refers to a permanent loss of brain function that cannot resume spontaneously and cannot be restored by medical interventions. Function of the entire cerebrum and brain stem is lost, resulting in coma, no spontaneous respiration, and loss of all brain stem reflexes. Spinal reflexes, including deep tendon, plantar flexion, and withdrawal reflexes, may remain. […] The diagnosis of brain death is equivalent to the persons death. No further treatment can prevent death. […] After brain death is confirmed, all supporting cardiac and respiratory treatments are ended. Cessation of ventilatory support results in terminal arrhythmias. Spinal motor reflexes may occur during terminal apnea; they include arching of the back, neck turning, stiffening of the legs, and upper extremity flexion (the so-called Lazarus sign). Family members who wish to be present when the ventilator is shut off need to be warned of such reflex movements.

• #2 Brain death diagnosis | STROKE MANUAL

  https://www.stroke-manual.com/brain-death-diagnosis/

  absence of abnormal postural responses, such as decorticate or decerebrate posturing, evoked by painful stimuli […] absence of spontaneous eye movements or abnormal eye position […] non-reactive moderately dilated or mydriatic pupils […] repeated tests show the irreversibility of the clinical condition […] when the accurate evaluation of a component of the BD/DNC neurologic examination cannot be assessed safely, clinicians must perform ancillary testing to complete the BD/DNC determination […] there must be no doubt about the cause of BD/DNC and the irreversibility of brain damage […] exclude all potentially reversible causes […] severe hypotension maintain SBP 100 mm Hg and mean arterial pressure (MAP) 75 mm Hg […] neuroendocrine function can persist in patients with permanent injury to the brain and is not inconsistent with the whole brain standard of death

• #2

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

  Brain stem death is a clinical diagnosis in most countries. The accuracy, reliability, reproducibility and ease in carrying out clinical tests make the process of clinical evaluation sufficient for establishing the diagnosis. […] Brain stem death is a nonfunctional state of the brain stem, where all signs of brain stem activity are absent. […] 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. […] 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.

• #2

  https://step2.medbullets.com/neurology/120269/brain-death-diagnosis

  A previously healthy 46-year-old female presents to the emergency department after a motor vehicle accident. The patient is unresponsive to noxious stimuli. Pupils are dilated and unresponsive to light. Oculovestibular and gag reflexes are absent. The patient is intubated due to loss of spontaneous respirations. After further workup, an apnea test is performed, which shows no respiratory response with a PaCO2 60 mm Hg. […] To determine brain death, one must do the following: neurologic exam, permanent irreversible coma, loss of response to painful stimuli from brain-originating motor area, loss of brainstem reflex, e.g., corneal, pupillary, jaw-jerk, oculovestibular, gag reflex. […] Apnea testing is performed after brain death criteria is met, e.g., eucapnia, normothermia, normotension, absence of hypoxia, to display absence of respiratory drive, no respiratory response with a PaCO2 60 mmHg or PaCO2 20 mmHg above baseline. […] Presence of spinal cord reflexes is still compatible with brain death.

• #2 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/

  Physicians and health care providers conduct a comprehensive assessment to determine brain death, performing several tests to confirm there is no brain activity in accordance with strict medical standards. […] Only after brain death has been confirmed and the time of death noted, can organ donation become a possibility.

• #2 Clinico-radiological related to early brain death factors | Medicina Intensiva

  https://www.medintensiva.org/en-clinico-radiological-related-early-brain-death-articulo-S217357272100148X

  To identify clinical and radiological factors associated to early evolution to brain death (BD), defined as occurring within the first 24h. […] Early BD (24h) was associated to GCS5, midline shift, effacement of the basal cisterns, cerebral sulci and suprasellar cistern, and ependymal transudation. […] Patients with endocranial hypertension progress into brain death (BD) when intracranial pressure (ICP) exceeds the systolic arterial pressure, thus leading to cerebral circulatory arrest, being the intracerebral hemorrhage (ICH) the most common etiology in Spain followed by traumatic brain injury (TBI), and subarachnoid hemorrhage (SAH). […] We know that most patients with severe brain injuries who progress into BD do so within the first 72h. […] Several studies have identified clinical and radiological signs predictive of progression into BD.

• #2 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

  Brain stem death is when a person has permanently lost the potential for consciousness and the capacity to breathe. These are the two definitions of life. This can happen even when a ventilator is keeping oxygen circulating through the blood and the heart beating. 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 someones brain is injured it becomes swollen. Because it is enclosed in the skull, it reaches a point where it cannot swell any more. This puts pressure on the brain stem. When this happens, blood and oxygen cannot reach the brain and it dies.

• #2 Clinico-radiological related to early brain death factors | Medicina Intensiva

  https://www.medintensiva.org/en-clinico-radiological-related-early-brain-death-articulo-S217357272100148X

  The objective of this study was to establish the existence of differences between clinical and radiological elements seen in patients who progress into early BD defined as death occurring within the first 24h compared to those patients who died under conditions of BD after 24h. […] The GCS score was 3 in 68.8% of the patients with early BD vs 38.2% of the patients with late BD. […] The presence of transudation kept a statistically significant correlation with progression into early BD. […] Total basal cistern effacement (36 patients from the early BD group vs 24 patients from the late BD group) kept a statistically significant correlation with progression into early BD. […] The radiological signs that, in our setting, are significantly associated with progression into BD within the first 24h are brain midline shift, the presence of active hydrocephaly, basal total cistern effacement, sulcal effacement, the loss of cortico-subcortical differentiation, and the lack of suprasellar cistern.

• #2

  https://viasonix.com/neurology-neurosurgery/brain-death/

  Brain Death, or Cerebral Circulatory Arrest, is the irreversible complete loss of brain function. This condition of brain damage is characterized by almost no volume blood flow to the brain and very high distal resistance to arterial flow. […] Transcranial Doppler (TCD) can help detect the different progression stages of cerebral circulatory arrest towards complete brain death. Distal resistance to flow increases sharply and TCD can serve as an ancillary modality for the detection and confirmation of brain death in addition to other modalities for brain death determination. […] A suspected cerebral circulatory arrest appears in various forms in the Doppler spectrum as the condition progresses. Measurements must be performed for both the anterior and posterior circulations. The various stages may include:

• #2

  https://viasonix.com/neurology-neurosurgery/brain-death/

  Absence or reverse of end-diastolic flow; […] Reverberating flow which appears as positive and negative retrograde blood flow such that the mean positive flow is around zero; […] Small and short systolic spikes; […] No signal at all (only under the condition that a valid measurement was previously made at the same site).

• #2 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/

  According to the American Academy of Neurology, “Death by neurologic criteria, commonly referred to as brain death, occurs in individuals who have sustained catastrophic brain injury, with no evidence of function of the brain as a whole, a state that must be permanent.” Brain death is legally and medically recognized as death. Brain death results from swelling in the brain; blood flow in the brain ceases and without blood to oxygenate the cells, the tissue dies. […] When a person deteriorates to brain death, the body’s entire system stops. You cannot breathe, your heart cannot beat and your body cannot function once your brain dies. Massive artificial medical measures must be started to maintain organ function (such as ventilated support), but these interventions are only a temporary measure.

• #2 Brain Death | National Kidney Foundation

  https://www.kidney.org/kidney-topics/brain-death

  No. A patient in a coma continues to have brain activity and function. When brain death occurs, all brain function ceases and there is no chance of recovery. […] After the diagnosis of brain death is made there is no chance of recovery. […] Once the diagnosis of brain death is made, an individual is pronounced legally dead. […] No. When someone is dead, there is no feeling of pain or suffering.

• #2 Neurological evolution of severe baclofen intoxication: from brain death mimic to recovered brain function | BMJ Case Reports

  https://casereports.bmj.com/content/16/10/e257391

  Patients with brain death have by definition irreversible and complete loss of brainstem reflexes. […] Severe baclofen intoxication can mimic brain death clinically and is associated with temporary pathological electroencephalographic findings. […] Clinical signs resembling brain death lasted for the first 6 hours after admission with gradual return. […] Gradual normalisation of EEG and reappearance of brainstem reflexes within the first 24 hours are noted in severe cases of baclofen intoxication. […] This case study highlights the detailed clinical course and detailed continuous EEG monitoring of a severe baclofen intoxication over time which initially mimicked brain death clinically for 6 hours and presented with an initial burst-suppression EEG pattern which resolved within 10 hours during continuous monitoring.

• #2 Brain Death – StatPearls – NCBI Bookshelf

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

  Brain death, both a legal and clinical term, has been present in medical literature and texts for many years and was defined by the Uniform Determination of Death Act (UDDA) in 1981. […] 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%. […] The physiology of brain death is similar regardless of the etiology. Inadequate tissue oxygenation leads to a progressive cascade of further edema, increasing intracranial pressure (ICP), a further decrease in cerebral perfusion and eventual herniation, or complete cessation of blood flow and aseptic necrosis of brain tissue. […] The prognosis of brain death, by definition, is 100% fatal.

• #2

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

  The medullary reticular formation (RF) contains the vital centers controlling heartbeat, breathing and circulation. […] The process implies that once a person is brain dead, it is unethical to continue treatment. […] 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.

• #2 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. […] Some of the signs of brain death include: The pupils dont respond to light. The person shows no reaction to pain. The eyes dont blink when the eye surface is touched (corneal reflex). The eyes dont move when the head is moved (oculocephalic reflex). The eyes dont move when ice water is poured into the ear (oculo-vestibular reflex). There is no gagging reflex when the back of the throat is touched. The person doesnt breathe when the ventilator is switched off. An electroencephalogram test shows no brain activity at all. […] Brain death means the person has died. […] It is important for the medical staff members to fully explain that brain death is final, and that the person is dead and has no chance of ever regaining consciousness again. […] In some cases, a person who is brain dead may be a candidate for organ donation.

• #3 Brain Death: What It Is, Stages & Criteria

  https://my.clevelandclinic.org/health/diseases/brain-death

  Brain death is when a medical condition like a stroke or a traumatic brain injury causes major and permanent damage to your brain. In brain death, you’re unconscious and you can’t breathe on your own. Healthcare providers follow medical criteria (guidelines) before diagnosing brain death. They perform specific tests before making a final diagnosis. […] Brain death is the medical and legal term for death that happens when your brain stops working. In brain death, injury or illness does severe, permanent damage to your entire brain and brainstem. Your brainstem manages your breathing and heart rate. Your brain manages senses like sight, sound and touch, and abilities like motor movement. […] Because people’s brains drive these essential functions, someone is legally dead when they’re diagnosed with brain death. Healthcare providers follow established medical criteria (guidelines) to determine if someone is brain dead.

• #3 Brain Death | National Kidney Foundation

  https://www.kidney.org/kidney-topics/brain-death

  Brain death is the complete and irreversible loss of all brain function. It is diagnosed through clinical tests and confirmed by medical guidelines. […] The diagnosis of brain death is defined as „death based on the absence of all neurologic function.” […] Brain death is a legal definition of death. It is the complete stopping of all brain function and cannot be reversed. It means that, because of extreme and serious trauma or injury to the brain, the body’s blood supply to the brain is blocked, and the brain dies. Brain death is death. It is permanent. […] A doctor will do tests to make a diagnosis of brain death. These tests are based on sound and legally accepted medical guidelines. Tests include a clinical examination to show that an individual has no brain reflexes and cannot breathe on his or her own.

• #3 Quick Facts:Brain Death – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/quick-facts-brain-spinal-cord-and-nerve-disorders/coma-and-impaired-consciousness/brain-death

  Brain death is when a person’s brain has completely stopped working but the body is being kept alive by breathing machines and medicines. […] People who are brain dead are unaware and can’t think or feel. They can’t move or breathe. Their brain stops controlling automatic body functions such as heartbeat and blood pressure. People with brain death are considered legally dead. […] No one who’s brain dead ever recovers. Brain death is different from coma. People in a coma have some brain function and sometimes recover. […] If there’s no sign of brain activity, doctors sometimes test again 6 to 24 hours later to make sure the person again shows no response. After testing twice with no response, doctors know that the person is brain dead. […] People with no electrical activity or blood flow in the brain have brain death. But these tests aren’t required.

• #3 Clinico-radiological related to early brain death factors | Medicina Intensiva

  https://www.medintensiva.org/en-clinico-radiological-related-early-brain-death-articulo-S217357272100148X

  To identify clinical and radiological factors associated to early evolution to brain death (BD), defined as occurring within the first 24h. […] Early BD (24h) was associated to GCS5, midline shift, effacement of the basal cisterns, cerebral sulci and suprasellar cistern, and ependymal transudation. […] Patients with endocranial hypertension progress into brain death (BD) when intracranial pressure (ICP) exceeds the systolic arterial pressure, thus leading to cerebral circulatory arrest, being the intracerebral hemorrhage (ICH) the most common etiology in Spain followed by traumatic brain injury (TBI), and subarachnoid hemorrhage (SAH). […] We know that most patients with severe brain injuries who progress into BD do so within the first 72h. […] Several studies have identified clinical and radiological signs predictive of progression into BD.

• #3 Diagnosis of brain death – UpToDate

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

  Brain death implies the permanent absence of cerebral and brainstem functions. […] Brain death signifies the complete, irreversible cessation of brain function, including the capacity for the brainstem to regulate respiratory and vegetative activities. […] 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.

• #3

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

  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. […] But they will not ever regain consciousness or start breathing on their own again. They have already died. […] After brain death, it is not possible for someone to remain conscious. […] Brain death can happen when the blood or oxygen supply to the brain is stopped. […] Brain death is permanent.

• #3 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

  The person will be unresponsive, they will not feel pain nor be in any discomfort. When we suspect brain stem death we need to carry out a series of strict tests. These are done by two senior doctors and they will carry these tests out twice. […] Tests for brain stem death: No pupil reaction to light, No blink reaction, No response to pain, No cough or gag reflex, No natural eye movement, No attempt to breathe when taken off the ventilator.

• #3 Brain Death – Neurologic Disorders – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/neurologic-disorders/coma-and-impaired-consciousness/brain-death

  Brain death, also known as brain death/death by neurologic criteria, refers to a permanent loss of brain function that cannot resume spontaneously and cannot be restored by medical interventions. Function of the entire cerebrum and brain stem is lost, resulting in coma, no spontaneous respiration, and loss of all brain stem reflexes. Spinal reflexes, including deep tendon, plantar flexion, and withdrawal reflexes, may remain. […] The diagnosis of brain death is equivalent to the persons death. No further treatment can prevent death. […] After brain death is confirmed, all supporting cardiac and respiratory treatments are ended. Cessation of ventilatory support results in terminal arrhythmias. Spinal motor reflexes may occur during terminal apnea; they include arching of the back, neck turning, stiffening of the legs, and upper extremity flexion (the so-called Lazarus sign). Family members who wish to be present when the ventilator is shut off need to be warned of such reflex movements.

• #3

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

  Brain stem death is a clinical diagnosis in most countries. The accuracy, reliability, reproducibility and ease in carrying out clinical tests make the process of clinical evaluation sufficient for establishing the diagnosis. […] Brain stem death is a nonfunctional state of the brain stem, where all signs of brain stem activity are absent. […] 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. […] 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.

• #3

  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 […] a person’s heartbeat and breathing can only be maintained using a ventilator […] there must be clear evidence that serious brain damage has occurred and it cannot be cured. […] The tests used to determine brain stem death are: a torch is shone into both eyes to see if they react to the light […] the person is disconnected from the ventilator for a short period of time to see if they make any attempt to breathe on their own. […] Brain death is diagnosed if a person fails to respond to all of these tests. […] Occasionally, a person’s limbs or torso (the upper part of the body) may move after brain stem death. These movements are spinal reflexes and do not involve the brain at all. They will not change the diagnosis of brain death.

• #3 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. […] Most imaging tests for brain death rely on the absence of cerebral blood flow as a surrogate for brain death. […] Furthermore, it is essential to realize that the absence of brain perfusion implies brain death, but the converse is not true. […] CT angiography relies upon the non-opacification of intracranial vessels, and the vessels that are chosen can affect the sensitivity and specificity of the test. […] It is also crucial to note that the timing of the study is different to a normal diagnostic study where the aim is to image as early as possible during the arterial phase to avoid excessive venous opacification. […] This consensus is for adult patients only (not pediatric patients).

• #3

  https://link.springer.com/article/10.1007/s00415-023-11938-1

  An automated digital screening tool (DETECT) has been developed to aid in the early identification of patients who are at risk of developing brain death during critical care. […] The primary target condition was the eventual diagnosis of brain death. […] The screening targeted a combination of coma, indicated by a Richmond Agitation Sedation Scale (RASS) score of 4 or 5 or Glasgow Coma Scale (GCS) score of 6, along with manually assessed absence of bilateral pupillary light reflexes, both of which are considered early indicators of impending brain death. […] The DETECT screening tool accurately identified all confirmed cases of brain death with a sensitivity of 100%, indicating no false negatives. […] The mean time between initial notification and final diagnosis of brain death was 3.6 days. […] Our findings suggest that implementing an automated digital screening tool to monitor routine clinical data can facilitate the early detection of patients who may be at risk of developing brain death during neurocritical care.

• #3 Facts about brain death and how it’s determined – Gift of Life Michigan

  https://giftoflifemichigan.org/blog/facts-about-brain-death-and-how-its-determined

  Brain death is death. […] Brain death is the irreversible and complete loss of brain and brain stem function. […] Brain death typically occurs after a major injury or illness where the blood supply to the brain is blocked, or the brain begins to swell within the skull. […] These traumatic events cause the brain to lose oxygen or begin to swell beyond recovery. […] Brain death is not the same as a coma or a prolonged vegetative state. […] Brain death is determined by strict medical and legal criteria. […] A patient must undergo extensive testing and verifications before they are declared brain dead by a physician. […] In brain death, patients dont react to noise, lights or touch as they would before a brain injury. […] If the patient has a catastrophic brain injury, they cant breathe on their own and rely on ventilators.

• #3

  https://childrenswi.org/publications/teaching-sheet/west-towers/1357-brain-death

  Your child has suffered severe injuries or illness to their brain. These may be so severe that the brain cannot possibly recover. This means that the brain has died. When someones brain is dead, they have died. […] Brain death is permanent and cannot be reversed. […] Once brain death happens, all brain functioning has stopped. It cannot be restarted. […] No. This has never happened. The injury to the brain is too severe. Brain death is final and cannot change. […] After brain death, nothing can be done to save your childs life.

• #3 Brain death | Organ Donation, Coma & Diagnosis | Britannica

  https://www.britannica.com/science/brain-death

  brain death, State of irreversible destruction of the brain. […] Such criteria include deep coma with a known cause, absence of any brainstem functions (e.g., spontaneous respiration, pupil reactions, gag and cough reflexes), and exclusion of hypothermia, drugs, and poison as causes. […] Organ donors must be declared brain-dead before their organs may be removed for transplant.

• #3 Brain death – Wikipedia

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

  The diagnosis of brain death is often required to be highly rigorous, in order to be certain that the condition is irreversible. Legal criteria vary, but in general require neurological examinations by two independent physicians. The exams must show complete and irreversible absence of brain function (brain stem function in UK), and may include two isoelectric (flat-line) EEGs 24 hours apart.

• #4 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

  Brain stem death is when a person has permanently lost the potential for consciousness and the capacity to breathe. These are the two definitions of life. This can happen even when a ventilator is keeping oxygen circulating through the blood and the heart beating. 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 someones brain is injured it becomes swollen. Because it is enclosed in the skull, it reaches a point where it cannot swell any more. This puts pressure on the brain stem. When this happens, blood and oxygen cannot reach the brain and it dies.

• #4

  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 […] a person’s heartbeat and breathing can only be maintained using a ventilator […] there must be clear evidence that serious brain damage has occurred and it cannot be cured. […] The tests used to determine brain stem death are: a torch is shone into both eyes to see if they react to the light […] the person is disconnected from the ventilator for a short period of time to see if they make any attempt to breathe on their own. […] Brain death is diagnosed if a person fails to respond to all of these tests. […] Occasionally, a person’s limbs or torso (the upper part of the body) may move after brain stem death. These movements are spinal reflexes and do not involve the brain at all. They will not change the diagnosis of brain death.

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