Clinical diagnosis of brain death: Prerequisites and criteria (UpToDate – login required.)

Prerequisites

Clinical or neuroimaging evidence of an acute central nervous system (CNS) catastrophe (eg, traumatic brain injury, subarachnoid hemorrhage) Exclusion of complicating medical conditions that may confound clinical assessment (no severe electrolyte, acid-base, endocrine, or circulatory [ie, shock] disturbance) No drug intoxication or poisoning, including any sedative drug administered in hospital, which may confound the clinical assessment Core temperature >36°C (97°F) Systolic blood pressure >100 mmHg; vasopressors may be required

Examination findings

Coma Absent brain-originating motor response, including response to pain stimulus above the neck or other brain-originating movements (eg, seizures, decerebrate or decorticate posturing) Absent pupillary light reflex; pupils are midposition (3.5 to 4 mm) Absent corneal reflexes Absent oculocephalic (doll’s eyes) and oculovestibular reflexes (caloric responses) Absent jaw jerk Absent gag reflex Absent cough with tracheal suctioning Absent sucking or rooting reflexes (in neonates) Apnea as demonstrated by apnea test

Observation period

At least 6 hours; longer time periods recommended in children and for certain conditions such as after cardiac arrest

---

See also:

DynaMed. Brain Death Determination in Adults. EBSCO Information Services. [updated 2020 Nov 25, cited 2021 May 21]. Accessed May 20, 2021. Registration and login required.

Starr R, Tadi P, Pfleghaar N. Brain Death. 2021 Jan 31. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–.

Wijdicks EF, Varelas PN, Gronseth GS, Greer DM; American Academy of Neurology. Evidence-based guideline update: determining brain death in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2010 Jun 8;74(23):1911-8. Full-text for Emory users.

Drake M, Bernard A, Hessel E. Brain Death. Surg Clin North Am. 2017 Dec;97(6) :1255-1273. Full-text for Emory users.

More PubMed results on brain death determination, including challenges, ethics, and controversies.

---