CLINICAL DIAGNOSIS OF BRAIN DEATH
The guidelines and clinical diagnosis for determining brain death
differ somewhat in various countries and among institutions in the United States.
However, the principle seems similar,[1]
[2]
[10]
and clinical diagnosis of brain death should
be performed in three steps:
- Establishing the cause of disease
- Excluding certain potentially reversible syndromes that may produce signs
similar to brain death
- Demonstrating clinical signs of brain death: coma, brainstem areflexia,
and apnea
Confirmatory tests in the determination of brain death are not
always mandatory, but they are desirable, especially when the clinical picture is
confusing. In general, two examinations separated by at least 6 hours are required
to establish the diagnosis of brain death. Most codes mandate that the clinical
diagnosis be confirmed by two or three physicians who are independent of the transplantation
team, and at least one of the physicians is required to be a specialist in neurology,
neurosurgery, or anesthesiology.
