scholarly journals Brain Blood Flow in the Neurological Determination of Death: Canadian Expert Report

2008 ◽  
Vol 35 (2) ◽  
pp. 140-145 ◽  
Author(s):  
Sam D. Shemie ◽  
Donald Lee ◽  
Michael Sharpe ◽  
Donatella Tampieri ◽  
Bryan Young
Keyword(s):  
Blood Flow ◽  
Brain Death ◽  
Imaging Techniques ◽  
Radionuclide Angiography ◽  
Brain Blood Flow ◽  
Determination Of Death ◽  
Xenon Ct ◽  
Clinical Criteria ◽  
Canadian Council

The neurological determination of death (NDD, brain death) is principally a clinical evaluation. However, ancillary testing is required when there are factors confounding the clinical determination or when it is impossible to complete the minimum clinical criteria. At the time of the 2003 Canadian Forum clarifying the criteria for brain death, 4-vessel cerebral angiography or radionuclide angiography were the recommended tests and the electroencephalogram was no longer supported. At the request of practitioners in the field, the Canadian Council for Donation and Transplantation sponsored the assembly of neuroradiology and neurocritical care experts to make further recommendations regarding the use of ancillary testing. At minimum, patients referred for ancillary testing should be in a deep unresponsive coma with an established etiology, in the absence of reversible conditions accounting for the unresponsiveness and the clinical examination should be performed to the fullest extent possible. For newborns, children and adults, demonstration of the absence of brain blood flow by following recommended imaging techniques fulfill the criteria for ancillary testing: 1. radionuclide angiography or CT angiography 2. traditional 4-vessel angiography 3. Magnetic resonance angiography or Xenon CT. In the absence of neuroimaging, an established cardiac arrest, as defined by the permanent loss of circulation, fulfills the ancillary criteria for the absence of brain blood flow. Acknowledging the existing limitations in this field, further research validating current or evolving techniques of brain blood flow imaging are recommended.

Brain Death in the Newborn

PEDIATRICS ◽  
1989 ◽  
Vol 84 (3) ◽  
pp. 429-437
Author(s):  
Stephen Ashwal ◽  
Sanford Schneider
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Brain Death ◽  
Clinical Findings ◽  
Term Infants ◽  
Clinical Criteria ◽  
Brain Dead ◽  
Electroencephalographic Activity ◽  
Radionuclide Uptake

The clinical courses of 18 preterm and term infants less than 1 month of age in whom brain death was diagnosed were retrospectively reviewed. Clinical diagnosis was determined neurologically and included (1) coma, (2) apnea, manifested by inability to sustain respiration, and (3) absent brainstem reflexes. Electroencephalograms were performed in all patients; 17 patients had adequate cerebral blood flow as estimated by radionuclide imaging. The results indicate that (1) neurodiagnostic tests such as electroencephalograms and radionuclide scanning reconfirmed clinically determined brain death in only one half to two thirds of patients; (2) electrocerebral silence in the absence of barbiturates, hypothermia, or cerebral malformations during 24 hours was confirmatory of brain death if the clinical findings remained unchanged; (3) absence of radionuclide uptake associated with initial electrocerebral silence was associated with brain death; (4) term infants clinically brain dead for 2 days and preterm infants brain dead for 3 days did not survive despite electroencephalogram or cerebral blood flow status; and (5) phenobarbital levels > 25 µg/ mL may suppress electroencephalographic activity in this age group. The findings suggest that determination of brain death in the newborn can be made solely by using clinical criteria. Confirmatory neurodiagnostic studies are of value because they can potentially shorten the period of observation.

scholarly journals Erratum to: Should ancillary brain blood flow analyses play a larger role in the neurological determination of death?

2016 ◽  
Vol 63 (9) ◽  
pp. 1116-1116
Author(s):  
Derek J. Roberts ◽  
Kate A. M. MacCulloch ◽  
Eric J. Versnick ◽  
Richard I. Hall
Keyword(s):  
Blood Flow ◽  
Brain Blood Flow ◽  
Determination Of Death

scholarly journals Should ancillary brain blood flow analyses play a larger role in the neurological determination of death?

2010 ◽  
Vol 57 (10) ◽  
pp. 927-935 ◽  
Author(s):  
Derek J. Roberts ◽  
Kate A. M. MacCulloch ◽  
Eric J. Versnick ◽  
Richard I. Hall
Keyword(s):  
Blood Flow ◽  
Brain Blood Flow ◽  
Determination Of Death

scholarly journals Neurological determination of death in isolated brainstem lesions: A case report to highlight the issues involved

2019 ◽  
Vol 21 (3) ◽  
pp. 269-273 ◽  
Author(s):  
Alex Manara ◽  
Panayiotis Varelas ◽  
Martin Smith
Keyword(s):  
Blood Flow ◽  
Case Report ◽  
Cerebral Circulation ◽  
Posterior Circulation ◽  
Determination Of Death ◽  
International Consensus ◽  
Brainstem Lesions ◽  
Posterior Cerebral Circulation ◽  
Isolated Brainstem

The neurological determination of death in patients with isolated brainstem lesions or by disruption of the posterior cerebral circulation is uncommon and many intensivists may never see such a case in their career. It is also the only major difference between the “whole brain” and “brain stem” formulations for the neurological determination of death. We present a case of a patient with infarction of the structures supplied by the posterior cerebral circulation in whom death was diagnosed using neurological criteria, to illustrate the issues involved. We also suggest that international consensus may be achieved if ancillary tests, such as CT angiography, are made mandatory in this situation o demonstrate loss of blood flow in the anterior cerebral circulation as well the posterior circulation.

scholarly journals Pope John Paul II and the Neurological Standard for the Determination of Death: A Critical Analysis of his Address to the Transplantation Society

2017 ◽  
Vol 84 (2) ◽  
pp. 155-186 ◽  
Author(s):  
Doyen Nguyen
Keyword(s):  
Brain Death ◽  
Catholic Church ◽  
The Body ◽  
Human Organism ◽  
Determination Of Death ◽  
Pope John Paul Ii ◽  
John Paul Ii ◽  
The Brain ◽  
The Catholic Church

The introduction of the “brain death” criterion constitutes a significant paradigm shift in the determination of death. The perception of the public at large is that the Catholic Church has formally endorsed this neurological standard. However, a critical reading of the only magisterial document on this subject, Pope John Paul II's 2000 address, shows that the pope's acceptance of the neurological criterion is conditional in that it entails a twofold requirement. It requires that certain medical presuppositions of the neurological standard are fulfilled, and that its philosophical premise coheres with the Church's teaching on the body-soul union. This article demonstrates that the medical presuppositions are not fulfilled, and that the doctrine of the brain as the central somatic integrator of the body does not cohere either with the current holistic understanding of the human organism or with the Church's Thomistic doctrine of the soul as the form of the body. Summary The concept of “brain death” (the neurological basis for legally declaring a person dead) has caused much controversy since its inception. In this regard, it has been generally perceived that the Catholic Church has officially affirmed the “brain death” criterion. The address of Pope John Paul II in 2000 shows, however, that he only gave it a conditional acceptance, one which requires that several medical and philosophical presuppositions of the “brain death” standard be fulfilled. This article demonstrates, taking into consideration both the empirical evidence and the Church's Thomistic anthropology, that the presuppositions have not been fulfilled.

RADIONUCLIDE CEREBRAL BLOOD FLOW IMAGING AS AN ADJUNCT IN THE DETERMINATION OF BRAIN DEATH IN CHILDREN

1982 ◽  
Vol 10 (3) ◽  
pp. 215
Author(s):  
Bernard H. Holzman ◽  
Richard G. Curless ◽  
George N. Sfakianakis ◽  
Cosimo Ajmone-Marsan ◽  
Jorge E. Montes
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Brain Death ◽  
Flow Imaging ◽  
Blood Flow Imaging

Specificity of Radionuclide Brain Blood Flow Testing in Brain Death: Case Report and Review

2010 ◽  
Vol 25 (1) ◽  
pp. 53-64 ◽  
Author(s):  
Ari R. Joffe ◽  
Laurance Lequier ◽  
Dominic Cave
Keyword(s):  
Blood Flow ◽  
Case Report ◽  
Brain Death ◽  
Brain Blood Flow ◽  
Death Case

scholarly journals Determination of Death: Ethical and Biomedical Update with International Consensus

2021 ◽  
Author(s):  
Md. Shah Alam Panna
Keyword(s):  
Life Support ◽  
Scientific Progress ◽  
Medical Intervention ◽  
Determination Of Death ◽  
Irreversible Loss ◽  
International Consensus ◽  
Clinical Criteria ◽  
Life And Death ◽  
The Moment

Humanity has been confronted with the concept and criteria of death for millennia and the line between life and death sustains to be debated. The profound change caused by life support technology and transplantation continues to challenge our notions of life and death. Despite scientific progress in the previous few decades, there remain big variations in diagnosis criteria applied in each country. Death is a process involving cessation of physiological function and determination of death is the final event in that process. Legally, a patient could be declared dead due to lack of brain function, and still may have a heartbeat when on a mechanical ventilator. Though there is no point in supporting ventilation in a dead person, withdrawing a ventilator before the legal criteria for death may involve the physician in both civil and criminal proceedings. To identify the moment of death is vital to avoid the use of unnecessary medical intervention on a patient who has already died and to ensure the organ donation process, clear and transparent. The age-old standard of determination of death is somatic standard and cardiopulmonary standard. Harvard report (1968) defines irreversible coma as a replacement criterion for death and prescribed clinical criteria for the permanently nonfunctioning brain. The current unifying concept of death: irreversible loss of the capacity for consciousness combined with irreversible loss of the capacity to breathe. WHO (2014) adopted minimum determinant death criteria, acceptable for medical practice globally, achieving international consensus on clinical criteria to maintain public trust and promote ethical practices that respect fundamental rights of individuals and minimize philosophical and biomedical debate in human death. AAN (2019) endorses that the brain death is the irreversible loss of all functions of the entire brain and equivalent to circulatory death.

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