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Determination of Brain Death/Death by Neurologic Criteria: The World Brain Death Project

By Currents Editor posted 09-02-2020 07:28


Journal of the American Medical Association (08/03/20)  doi: 10.1001/jama.2020.11586
Greer, David M.; Shemie, Sam D.; Lewis, Ariane; et al.

A new report provides guidelines for determining brain death in children and adults. The World Brain Death Project consensus statement — based on a literature review from January 1992 through April 2020 and the expert opinion of a large multidisciplinary, international panel — includes recommendations for the minimum clinical criteria needed for the determination of brain death/death by neurologic criteria (BD/DNC). “The determination of BD/DNC is a clinical diagnosis, and given the implications and consequences of this diagnosis, a conservative approach and criteria are recommended,” the authors write. The patient must have an established neurologic diagnosis that can result in the complete and irreversible loss of all brain function, and any confounding conditions or diseases that may appear like BD/DNC must be ruled out. Determining BD/DNC may include a clinical examination that demonstrates coma, brainstem areflexia, and apnea. The statement lists eight factors to consider in that examination. Additional consideration should be given to children, individuals receiving extracorporeal membrane oxygenation, and those receiving therapeutic hypothermia, and for religious, societal, and cultural factors; legal requirements; and the availability of resources. “The recommendations have widespread international society endorsement and can serve to guide professional societies and countries in the revision or development of protocols and procedures for determination of brain death/death by neurologic criteria, leading to greater consistency within and between all countries,” the authors conclude.


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