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Journal Article
The diagnosis of brain death
2009
Overview
Physicians, health care workers, members of the clergy, and laypeople
throughout the world have accepted fully that a person is dead when his
or her brain is dead. Although the widespread use of mechanical
ventilators and other advanced critical care services have transformed
the course of terminal neurologic disorders. Vital functions can now be
maintained artificially for a long period of time after the brain has
ceased to function. There is a need to diagnose brain death with utmost
accuracy and urgency because of an increased awareness amongst the
masses for an early diagnosis of brain death and the requirements of
organ retrieval for transplantation. Physicians need not be, or consult
with, a neurologist or neurosurgeon in order to determine brain death.
The purpose of this review article is to provide health care providers
in India with requirements for determining brain death, increase
knowledge amongst health care practitioners about the clinical
evaluation of brain death, and reduce the potential for variations in
brain death determination policies and practices amongst facilities and
practitioners. Process for brain death certification has been discussed
under the following: 1. Identification of history or physical
examination findings that provide a clear etiology of brain
dysfunction. 2. Exclusion of any condition that might confound the
subsequent examination of cortical or brain stem function. 3.
Performance of a complete neurological examination including the
standard apnea test and 10 minute apnea test. 4. Assessment of
brainstem reflexes. 5. Clinical observations compatible with the
diagnosis of brain death. 6. Responsibilities of physicians. 7. Notify
next of kin. 8. Interval observation period. 9. Repeat clinical
assessment of brain stem reflexes. 10. Confirmatory testing as
indicated. 11. Certification and brain death documentation. DOI:
10.4103/0972-5229.53108
Publisher
Medknow Publications on behalf of the Indian Society of Critical Care Medicine,Medknow Publications and Media Pvt. Ltd,Jaypee Brothers Medical Publishers Ltd,Medknow Publications
