53 - Brain death

Abstract

Death was historically defined only by confirmation of cessation of cardiorespiratory function, but the concept of brain death, now more accurately referred to as the determination of death by neurological criteria, was introduced into clinical practice almost 50 years ago. From a legal and scientific perspective, brain death is a definable event which is established as a legitimate definition of death in most countries in the world. Practice guidelines for the determination of brain death are widely available but there is large international variation in their content and application. Clinical determination is the gold standard for the diagnosis of brain death in many countries, but ancillary investigations are required in some. The clinical determination of brain death incorporates three sequential but inter-dependent steps – fulfilment of essential preconditions, exclusion of reversible causes of coma and apnoea, and confirmation of brainstem areflexia and apnoea.