Table of contents
Brain death
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of brain death are prepared by our editorial team based on guidelines from the American Heart Association (AHA 2024) and the Congress of Neurological Surgeons (CNS/AAN/SCCM/AAP 2023).
1
2
Diagnostic investigations
General principles: as per AAN/AAP/CNS/SCCM 2023 guidelines, follow the standardized process in this guideline for the determination of BD/death by neurologic criteria unless otherwise legislated by local, regional, or federal authorities.
B
Show 3 more
More topics in this section
Consent acquisition
Prerequisites for evaluation (etiology)
Prerequisites for evaluation (timing)
Prerequisites for evaluation (hypothermia)
Prerequisites for evaluation (hypotension)
Prerequisites for evaluation (drugs and metabolic derangements)
Prerequisites for evaluation (neuroendocrine function)
Neurological evaluation (numbers of examinations)
Neurological evaluation (components)
Apnea testing
Ancillary testing (indications)
Ancillary testing (tests)
Determining time of death
Specific circumstances
Pregnant patients
As per AAN/AAP/CNS/SCCM 2023 guidelines:
Recognize that pregnancy in and of itself is not a contraindication to BD/death by neurologic criteria evaluation. Assess and diagnose pregnant patients with catastrophic, permanent brain injuries for BD/death by neurologic criteria.
A
Educate and discuss with surrogate decision-makers the risks and benefits to the fetus of continuing maternal organ support, assisted by clinicians knowledgeable in maternal-fetal medicine, child neurology, and neonatology as needed, after determining BD/death by neurologic criteria in a pregnant patient.
B
Patient education
Family support
As per AAN/AAP/CNS/SCCM 2023 guidelines:
Provide support and guidance for families as they face difficult end-of-life decisions for their loved one who has sustained a catastrophic brain injury. Ensure that communication is clear, concise, and supportive and includes simple terminology that families can understand. Provide appropriate emotional support for the family.
B
Ensure that hospital policies include consideration of providing a reasonable period to accommodate families after the death of a family member and provide a process to resolve disagreements when families do not agree with the medical team about the initiation of the BD/death by neurologic criteria evaluation and/or termination of organ support after determination of BD/death by neurologic criteria.
B
Follow-up and surveillance
Quality improvement
Health professional training: as per AAN/AAP/CNS/SCCM 2023 guidelines, ensure that attending clinicians performing BD/death by neurologic criteria evaluation are appropriately credentialed members of the hospital medical personnel and adequately trained and competent in the evaluation of BD/death by neurologic criteria in pediatric or adult patients, as applicable (such as intensivists, neurologists, neurosurgeons) and in accordance with local laws and institutional standards.
A
Show 3 more
More topics in this section
Avoidance of conflict of interest