This document discusses brain death and how it is defined. It explains that brain death is a legal definition of death that means the complete and irreversible cessation of all brain function. The brain has died due to blocked blood flow even though the heart may still be beating with the help of life support. Signs of brain death include the absence of reflexes and the inability to breathe without a ventilator. Tests like EEG can confirm no brain activity remains. The document provides details on clinical evaluations and confirmatory tests used to determine brain death.

1. JOHNY WILBERT, M.SC[N]
LECTURER,
APOLLO INSTITUTE OF HOSPITAL MANAGEMENT
AND ALLIED SCIENCE

2.  The diagnosis of brain death is defined as "death
based on the absence of all neurologic function."
Families who have had a loved one declared brain
dead may have questions about what the term really
means.

3.  Brain death is a legal definition of death. It is
the complete and irreversible cessation
(stopping) of all brain function. It means that, as
a result of severe trauma or injury to the brain,
the body's blood supply to the brain is blocked,
and the brain dies. Brain death is death. It is
permanent and irreversible.

4.  Brain death is not the same as coma, because someone
in a coma is unconscious but still alive. Brain death
occurs when a critically ill patient dies sometime after
being placed on life support. This situation can occur
after, for example, a heart attack or stroke. The heart
continues to beat while the ventilator delivers oxygen
to the lungs (the heart can initiate its own beating
without nerve impulses from the brain) but, despite the
beating heart and warm skin, the person is dead. Since
the brain has stopped working, the person won’t
breathe if the ventilator is switched off.

5.  Some of the signs of brain death include:
 The pupils don’t respond to light.
 The person shows no reaction to pain.
 The eyes don’t blink when the eye surface is touched
(corneal reflex).
 The eyes don’t move when the head is moved
(oculocephalic reflex).
 The eyes don’t move when ice water is poured into the ear
(oculo-vestibular reflex).
 There is no gagging reflex when the back of the throat is
touched.
 The person doesn’t breathe when the ventilator is switched
off.
 An electroencephalogram test shows no brain activity at all.

6.  Many of the details of the clinical neurologic
examination to determine brain death cannot be
established by evidence-based methods. The detailed
brain death evaluation protocol that follows is intended
as a useful tool for clinicians. It must be emphasized
that this guidance is opinion-based. Alternative
protocols may be equally informative.

7.  I. The clinical evaluation (prerequisites).
 A. Establish irreversible and proximate cause
of coma.
 B. Achieve normal systolic blood pressure.
 C. Perform 2 neurologic examinations

8.  The clinical evaluation (neurologic assessment).
 A. Coma.
 B. Absence of brainstem reflexes.
 C. Apnea Test

9.  Common confirmatory tests in Brain Death
 Cerebral angiography
 Electroencephalography
 Transcranial Doppler ultrasonography
 Cerebral scintigraphy (technetium Tc 99m
hexametazime)