Pitfalls of Brain Death Determination

Adapted from Wijdicks et al., 2010.

ABG = arterial blood gas; BP = blood pressure; CPAP = continuous positive airway pressure; PEEP = positive end expiratory pressure; TMJ = temporomandibular joints

Brain death determination allows closure and options for organ donation. There is no medical rationale to continue care if there is no consent for organ donation. No intensive care unit has the obligation to care for a legally deceased person, and in the extreme it would be unethical if holding the bed can cause refusal of necessary transfers of other patients.

KEY POINTS TO REMEMBER REGARDING BRAIN DEATH DETERMINATION

Brain death determination is time-consuming and involves multiple tests.
Most time should be spent in finding possible confounding factors.
The diagnosis is based on a clinical neurologic examination and not on cerebral blood flow or an electrodiagnostic study.
Two examinations by 2 separate physicians are needed in infants and children.
In the U.S. one examination is sufficient in adults (> 18 years).
Some U.S. states require 2 physicians to examine the patient usually at approximately the same time.
Confirmatory tests are legally necessary in some countries