The lack of scientific evidence in clinical practice guideline in brain death determination: Implications for organ donation and transplantation

Brain death is the state of irreversible loss of the clinical functions of the brain. A patient must meet strict criteria to be declared brain dead. They must have suffered a known and demonstrably irreversible brain injury and must not have a condition that could render neurologic testing unreliable. If the patient meets these criteria, a formal brain death examination can be performed. The three findings in brain death are coma or unresponsiveness, absence of brainstem reflexes, and apnea. Brain death is closely tied to organ donation, because brain-dead patients represent approximately 90% of deceased donors and thus a large majority of donated organs. This review details a definition and overview of brain death, determination of brain death, and controversy over brain death, as well as the types of organ donation (living donation versus deceased donation), donation after brain death, and donation after cardiac death. A figure presents a comparison of organ donation after brain death and after cardiac death, and a table lists the American Academy of Neurology Criteria for Determination of Brain Death. This review contains 1 highly rendered figure, 3 table, and 20 references.

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Brain Death, Organ Donation, and Transplantation

Neurocritical Care ◽

10.1093/med/9780199375349.003.0026 ◽

2018 ◽

pp. 276-285

Author(s):

Hilary H. Wang ◽

David M. Greer

Keyword(s):

Brain Death ◽

Organ Donation ◽

The United States ◽

Apnea Test ◽

Unit Management ◽

Legal Context ◽

History Of ◽

Brain Death Determination ◽

Brain Dead ◽

Death Determination

This chapter reviews the history of brain death determination, current guidelines for performing the brain death examination including the apnea test, details of apnea testing, the role of brain dead donors in organ donation, physiologic changes seen in brain dead patients, and the relevant challenges in intensive care unit management of such patients for donor organ optimization. The goal of this chapter is to provide clear guidance for a critical care provider to perform an accurate and thorough brain death examination and to further the reader’s understanding of the historical and legal context surrounding brain death and organ donation in the United States.

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Update of Clinical Practice Guidelines for Brain Death Determination in an Academic Heath Center

Journal of Neuroscience Nursing ◽

10.1097/jnn.0000000000000110 ◽

2015 ◽

Vol 47 (1) ◽

pp. 44-50 ◽

Cited By ~ 1

Author(s):

Jennifer Jackson ◽

Melissa Willmarth-Stec ◽

Lori Shutter

Keyword(s):

Clinical Practice ◽

Brain Death ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Brain Death Determination ◽

Death Determination

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Beliefs and Brain Death

10.1093/med/9780190662493.003.0004 ◽

2017 ◽

Author(s):

Eelco F.M. Wijdicks

Keyword(s):

United States ◽

Native American ◽

Brain Death ◽

Cultural Diversity ◽

Organ Donation ◽

The United States ◽

Neurological Injury ◽

Brain Death Determination ◽

Death Determination

Globalization has increased cultural diversity in many communities. This has immediate implications for care of patients with catastrophic neurological injury and later discussions of brain death and organ donation. While the major religions in the United States—Christianity, Islam, and Judaism—have taken a tolerant position in these matters, some denominations within them are vigorously opposed to it. This chapter presents a range of cultural and religious views of brain death determination and organ donation. In addition to the three major religions, Buddhist and native American views regarding brain death determination as well as organ donation are discussed. Conflict resolution over organ donation is discussed along with the role of clergy in mediating such conflicts between families and medical staff.

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Brain Death and Organ Donation

10.2310/im.1459 ◽

2017 ◽

Author(s):

Thomas I. Cochrane

Keyword(s):

Brain Death ◽

Organ Donation ◽

Cardiac Death ◽

Donation After Cardiac Death ◽

Donation After Brain Death ◽

Brain Death Determination ◽

Brain Dead ◽

American Academy Of Neurology ◽

Death Determination

Brain death is the state of irreversible loss of the clinical functions of the brain. A patient must meet strict criteria to be declared brain dead. They must have suffered a known and demonstrably irreversible brain injury and must not have a condition that could render neurologic testing unreliable. If the patient meets these criteria, a formal brain death examination can be performed. The three findings in brain death are coma or unresponsiveness, absence of brainstem reflexes, and apnea. Brain death is closely tied to organ donation, because brain-dead patients represent approximately 90% of deceased donors and thus a large majority of donated organs. This review details a definition and overview of brain death, determination of brain death, and controversy over brain death, as well as the types of organ donation (living donation versus deceased donation), donation after brain death, and donation after cardiac death. A figure presents a comparison of organ donation after brain death and after cardiac death, and a table lists the American Academy of Neurology Criteria for Determination of Brain Death. This review contains 1 highly rendered figure, 3 table, and 20 references.

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Clinical Practice Guideline for Solid Organ Donation and Transplantation During the COVID-19 Pandemic

Transplantation Direct ◽

10.1097/txd.0000000000001199 ◽

2021 ◽

Vol 7 (10) ◽

pp. e755

Author(s):

Matthew J. Weiss ◽

Laura Hornby ◽

Farid Foroutan ◽

Sara Belga ◽

Simon Bernier ◽

...

Keyword(s):

Clinical Practice ◽

Organ Donation ◽

Clinical Practice Guideline ◽

Practice Guideline ◽

Solid Organ

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Clinical Problems in Brain Death Determination and Organ Donation

10.1093/med/9780190662493.003.0007 ◽

2017 ◽

Author(s):

Eelco F.M. Wijdicks

Keyword(s):

Brain Death ◽

Organ Donation ◽

Moral Dilemmas ◽

Therapeutic Interventions ◽

Neurological Illness ◽

Subsequent Discussion ◽

Brain Death Determination ◽

Death Determination ◽

Clinical Problems

There are clear guiding principles in the determination of brain death and subsequent discussion about organ donation. In most situations, brain death is straightforward to diagnose, consent is obtained for organ donation, and—for the endlessly waiting recipients—all goes well. But questions can arise, and occasionally physicians encounter problems. Advances in medical practice have also changed the way physicians approach catastrophic neurological illness, and the consequences of therapeutic interventions must be considered. The number of available ancillary tests also has increased over the years, creating difficulties with interpretation when the validity of the tests is insufficiently known. The diagnosis of brain death also may generate moral dilemmas. This chapter seeks to address solutions to common clinical problems in practice.

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