Declaration Of Brain Death Research Articles

Brain death.

Brain death is a condition widely recognized by philosophers, theologians, the public, and the law. Criteria for the determination of brain death have been progressively refined for almost 30 years. They involve clinical evidence of the loss of brain function and various periods of observation, which can often be shortened by confirmatory tests, particularly cerebral blood flow studies or electroencephalography. Prompt declaration of brain death is therefore possible. In addition, it is important for physicians to offer the possibility of organ donation to the patient's family both because organs are desperately needed and because many families desire this. A model algorithm for the determination of brain death, explanatory text, and appropriate references are presented to aid the development of protocols for individual and hospital use.

Declaration of brain death in neurosurgical and neurological practice.

A survey of neurosurgeons and neurologists assessed physician practices in the declaration of brain death. Ninety-four per cent of the respondents thought that the diagnosis of brain death was legitimate; most thought that it was justified by a failure of somatic survival after brain death. Fifty-four per cent of the respondents had made the diagnosis themselves 1 to 5 times a year. The criteria used to make the diagnosis varied significantly among the respondents. Most required the absence of a pupillary reflex (88%), the absence of a corneal reflex (85%), a lack of ventilatory effort with disconnection of the ventilator (84%), and the absence of eye movements with head turning (80%). Fewer required an absent cough reflex (61%) or gag reflex (69%), dilated pupils (59%), a body temperature under 90 degrees F (56%), or a blood barbiturate level of zero (43%). Over 65% required an isoelectric electroencephalogram; 29% required only one, and 36% required two electroencephalograms 24 hours apart. Twenty-six per cent required absent deep tendon reflexes. The time required for the declaration varied from 6 to 24 hours. There was wide variation in the response to a hypothetical situation in which the family of a patient fulfilling brain death criteria did not want death to be declared. Seventy-eight per cent of the respondents would continue ventilatory support, although about a third of these would declare the patient dead while doing so. Only 6% would stop the ventilator despite the family's wishes. These results substantiate a wide variation in the actions of neurologists and neurosurgeons in brain death declaration. This has important implications for decisions about death in neurology and neurosurgery.

Declaration of brain death in neurosurgical and neurological practice

Declaration of brain death in neurosurgical and neurological practice

Brain Death Criteria-Reply

<i>In Reply</i>.—Belsh's comments regarding our article¹are appreciated. We certainly agree that one must attempt to determine the cause for cessation of cerebral function before declaring brain death. This issue indeed was considered in our patients (criteria 4 and 5 and later on in the "Conclusions" section). Belsh also insists that there is a need for further confirmatory studies, other than an observation period and meeting the criteria set forth in our article. The major point of our article is that if 72 hours is taken as a period of observation with no change in the clinical examination during that period of time, the EEG and other studies may well be unnecessary. This becomes particularly important for patients hospitalized in centers where the technical and interpretive expertise in EEG studies is not readily available; one must also be concerned about the fact that angiographic and isotopic studies may, according