Brain Death Determination

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
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