Chapter 15 - The diagnosis of brain death

Summary

The diagnosis of brain death is universal based on the three cardinal features of coma, absence of brainstem reflexes, and apnea, but varies between countries, states, and even hospitals. Causes of brain death include only devastating neurological injuries. Examples include large strokes, tumors, infections, or trauma that results in severe brain edema. Clinicians must understand both the legal criteria regulating their practice and the relevant position statements providing detailed, practical guidelines, diligently abiding by both. A diagnosis of brain death requires complete and irreversible loss of clinically manifested function of the entire brain. The steps in diagnosing brain death can be broken down into four areas as described by the American Academy of Neurology (AAN): meeting prerequisites, performing the clinical examination, using ancillary testing if appropriate, and documentation and consideration for organ donation.