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Clinical diagnosis of brain death: Prerequisites and criteria

Clinical diagnosis of brain death: Prerequisites and criteria
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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