Determining Brain Death.

Abstract

Major complexities exist in the assessment of a patient with a catastrophic neurologic disorder that might have progressed to loss of all brain function. The determination of brain death and initial management of the potential organ donor is one of the major key tasks of the neurologist. This article addresses the potential for errors, mimickers, and uncertainties associated with ancillary tests for determining brain death. Major professional neurologic organizations including the American Academy of Neurology have published guidelines for the determination of brain death in both adults and children. Checklists are now available to assist physicians in the assessment of the patient. The clinical diagnosis of brain death in a patient with a catastrophic brain injury is determined by a comprehensive clinical examination that involves at least 25 individual assessments. It requires excluding confounding factors first (to confirm futility), examining the patient carefully with special attention to signs of brainstem function, and, finally, performing an apnea test. Once a patient is declared brain dead, organ donation may proceed after consent is obtained.