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Brain Death Dilemmas and the Use of Ancillary Testing

Webb, Adam MD; Samuels, Owen MD

doi: 10.1212/01.CON.0000415434.91771.9b
Practice Issues

The Uniform Determination of Death Act indicates that “an individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead,” with brain death being determined based on “accepted medical standards.” The AAN has published practice guidelines providing medical standards for the determination of brain death.1,2 The most recent AAN guideline update notes that “because of the deficiencies in the evidence base, clinicians must exercise considerable judgment when applying the criteria in specific circumstances” and that “ancillary tests can be used when uncertainty exists about the reliability of parts of the neurologic examination or when the apnea test cannot be performed.”2 This article presents two cases commonly encountered in clinical practice in which the findings of the guideline-specified clinical neurologic assessment may be difficult to interpret, hampering the clinical determination of brain death. In these circumstances, ancillary testing specifically assessing for cerebral circulatory arrest may be helpful.

Address correspondence to Dr Owen Samuels, The Emory Clinic, Building B, 2nd Floor, 1365-B Clifton Rd, NE, Ste 2200, Atlanta, GA 30322, owen.samuels@emoryhealthcare.org.

Relationship Disclosure: Drs Webb and Samuels report no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Drs Webb and Samuels report no disclosure.

© 2012 American Academy of Neurology
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