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Why is diagnosing brain death so confusing?

Ghoshal, Shivani; Greer, David M.

Current Opinion in Critical Care: April 2015 - Volume 21 - Issue 2 - p 107–112
doi: 10.1097/MCC.0000000000000180
NEUROSCIENCE: Edited by Michael N. Diringer

Purpose of review Although detailed practice parameters have been developed to help guide physicians in brain death determination, guidelines based on these parameters widely vary. The recent case of Jahi McMath not only highlights social misconceptions but also serves as a call to action to decrease medical variability and confusion regarding brain death determination. This review discusses common sources of variations in brain death determination – we divide these sources into before, during, and after brain death declaration.

Recent findings We use four key studies to elucidate variable practice in brain death determination. Poor training of examiners and patient qualifications for brain death examination prior to testing, incomplete apnea testing, repeat examinations during testing, and the sometimes unjustified use of ancillary testing are highlighted as main areas for improvement. Improved physician training and certification, as well as better standardization of hospital protocols, may be answers to more universal practice.

Summary Diagnosing brain death is confusing because of numerous variations in practice, but this variation can be improved. Improved and standardized physician training can help create a formal certification process for examiners and help create uniformity in brain death determination. National standards will also help decrease variability of practice.

Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA

Correspondence to David M. Greer, MD, MA, FCCM, FAHA, FNCS, FAAN, Department of Neurology, Yale University School of Medicine, 15 York Street, New Haven, CT 06530, USA. Tel: +1 203 785 5012; fax: +1 203 785 2238; e-mail:

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