Critical Matters Brain Death / Death by Neurologic Criteria
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Nov 30, 2023 Dr. David Greer, a neurologist and chair of the Boston University School of Medicine Department of Neurology, discusses the clinical guidelines for brain death and death by neurologic criteria. They cover topics such as evaluating brain death and donation, conducting the apnea test, limitations of ancillary tests, determining brain death and consent, and the importance of providing comfort to patients and families. They also share book recommendations and emphasize finding joy in everyday work.
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Terminology Matters
- 'Death by neurologic criteria' is more precise than the colloquial 'brain death' and emphasizes brain-based determination of death.
- The guideline uses 'permanent' (no spontaneous recovery and no restorative interventions) to distinguish prognosis from 'irreversible'.
Favor A Conservative, Unified Approach
- Combine adult and pediatric guidance where physiology allows but create pediatric carve-outs for age-specific differences.
- Use a conservative, meticulous approach and rule out confounders before declaring death by neurologic criteria.
When To Start Evaluation
- Consider brain death evaluation for patients with catastrophic neurologic injury and corroborating neuroimaging showing severe cerebral compromise.
- Wait at least 24 hours after cardiac arrest (longer if cooled) and re-image to avoid false positives.