J Korean Med Assoc.  2006 Jun;49(6):493-501. 10.5124/jkma.2006.49.6.493.

Determining Brain Death

• Kang JK

• KMID: 2137829
• DOI: http://doi.org/10.5124/jkma.2006.49.6.493

Abstract

Brain death is a clinical diagnosis. The three cardinal findings in brain death are coma or unresponsiveness, absence of brainstem reflexes, and apnea. The clinical examination of the brainstem includes testing of brainstem reflexes, determination of the patient's ability to breath spontaneously, and evaluation of the motor response to pain. Spontaneous and reflex movements originating from the spinal cord neurons may occur in brain-dead patients. An awareness of spinal reflexes may prevent delays in and misinterpretations of the brain-death diagnosis. In some countries including Korea, our country, confirmatory tests are required by law when determining brain death. However, a confirmatory test is not usually mandatory except for patients in whom specific components of clinical testing cannot be evaluated reliably.

Keyword

Bain death; Apnea; Spinal reflexes; Confirmatory tests

MeSH Terms

Apnea
Brain Death*
Brain Stem
Brain*
Coma
Diagnosis
Humans
Jurisprudence
Korea
Neurons
Reflex
Spinal Cord

Figure

• 

  Figure 1 Proposed guideline for the clinical diagnosis of brain death

• 

  Figure 2 Procedure for the apnea test in brain death

Reference

2. Wijdicks Eelco FM. Determining brain death in adults. Neurology. 1995. 45:1003–1011.

3. Morenski JD, Oro JJ, Tobias JD, Singh A. Determination of Death by Neurological Criteria. Journal of Intensive Care Medicine. 2003. 18:211–221.

4. Wijdicks EFM. The Diagnosis of Brain Death. N Engl J Med. 2001. 344:1215–1221.

5. Jorgensen EO. Spinal man after brain death. The unilateral extension-pronation reflex of the upper limbs as an indication of brain death. Acta Neurochir. 1973. 28:259–273.

6. Dosemeci M, Cengiz M, Yilmaz M, Ramazanglu A. Frequency of Spinal Reflex Movements on Brain-Dead Patients. Transplantation Proceedings. 2004. 36:17–19.

7. Bruce EN, Cherniack NS. Central Chemoreceptors. J Appl Physiol. 1987. 62:389–402.

8. Ropper AH, Kennedy SK, Russell L. Apnea testing in the diagnosis of brain death: clinical and physiological observations. J Neurosurg. 1981. 55:942–946.