Pediatric and Adult Brain Death/Death by Neurologic Criteria

Publication Date: October 11, 2023
Last Updated: October 12, 2023

General Principles for the BD/DNC Evaluation

Unless otherwise legislated by local, regional, or federal authorities, clinicians at institutions in the United States should follow the standardized process in this document for determination of BD/DNC. (B)
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BD/DNC cannot be determined in infants younger than 37 weeks, corrected gestational age, during BD/DNC evaluation; therefore, clinicians should not evaluate infants younger than 37 weeks, corrected gestational age, for BD/DNC. (B)
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To avoid COI, clinicians involved in BD/DNC determination must only consider the interests of their patient and avoid any direct involvement in decision-making regarding organ donation. (A)
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To avoid COI, any clinician involved with surgical recovery of organs for transplantation must not be involved with BD/DNC evaluation. (A)
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Patients undergoing BD/DNC evaluation must be cared for in an environment that allows adequate observation, to ensure the severity and permanency of the brain injury and exclude confounders, and has staff with appropriate expertise in managing the potential cardiopulmonary complications of apnea testing. (A)
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Patients with any evidence of consciousness or preservation of any brainstem reflex or who display motor movements that are mediated by the brain or brainstem or are spontaneously breathing do not meet established criteria and must not undergo BD/DNC testing. (A)
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Clinicians Who Perform BD/DNC Evaluations

Attending clinicians performing BD/DNC examinations must be appropriately credentialed members of the hospital's medical staff and be adequately trained and competent in the evaluation of BD/DNC in children or adults, as applicable (e.g., intensivists, neurologists, neurosurgeons, etc.) and in accordance with local laws and institutional standards. (A)
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In settings where acute and critical care advanced practice providers (APPs) are performing BD/DNC evaluations independently in accordance with local laws and institutional standards, they must be appropriately credentialed and adequately trained and competent in the evaluation of BD/DNC in children or adults, as applicable. (A)
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Trainees and acute and critical care APPs, in settings where they are not permitted to perform BD/DNC evaluations independently in accordance with local laws and institutional standards, must be directly supervised by an attending clinician who meets Recommendation 6a criteria who should be present at the patient's bedside for the entirety of the evaluation. (A)
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Clinicians performing BD/DNC examinations should have specific education in training on performing BD/DNC evaluation and demonstrate competency in the BD/DNC evaluation of child or adult patients, as appropriate, by such means as completion of a supervised BD/DNC evaluation in a clinical environment (Level B). Supplementary education on BD/DNC can include completion of a well-designed online or in-person training course. (B)
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Clinicians should provide support and guidance for families as they face difficult end-of-life decisions for their loved one who has sustained a catastrophic brain injury (Level B). Communication should be clear, concise, and supportive and include simple terminology that families can understand. Appropriate emotional support for the family should be provided. (B)
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Prerequisites for Determination of BD/DNC

Identification of the Etiology of Brain Injury

Clinicians must ascertain that a patient has sustained a catastrophic, permanent brain injury caused by an identified mechanism that is known to lead to BD/DNC before initiating a BD/DNC evaluation. (A)
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Clinicians should conduct further diagnostic evaluation and not undertake evaluation for BD/DNC if a patient is comatose, apneic, and has absent brainstem reflexes, and there is not an identified mechanism of brain injury that is known to lead to BD/DNC. (A)
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Clinicians should determine that neuroimaging is consistent with the mechanism and severity of brain injury. (B)
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Observation for Permanency

For infants and children younger than 24 months, clinicians should wait at least 48 hours after the acute brain injury before initiating the BD/DNC evaluation. (B)
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Clinicians must wait a sufficient amount of time after the brain injury occurs before initiating the BD/DNC evaluation to ensure there is no potential for recovery of brain function (Level A). This observation period must be based on the pathophysiology of the brain injury leading to the neurologic state of the patient. (A)
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Clinicians should wait a minimum of 24 hours after acute HIBI in patients aged 24 months and older before initiating the BD/DNC evaluation. (B)
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After medical or surgical interventions to treat elevated intracranial pressure, clinicians must wait a sufficient amount of time to ensure there is no recovery of brain function before initiating the BD/DNC evaluation (Level A). This observation period must be based on the pathophysiology of the brain injury leading to the neurologic state of the patient and the findings on neuroimaging. (A)
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Avoiding Inaccurate Determination of BD/DNC Caused by Hypothermia

Clinicians must ensure that patients' core body temperatures are maintained ≥36°C before performing a BD/DNC evaluation. (A)
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In patients whose core body temperature has been ≤35.5°C, clinicians should wait a minimum of 24 hours after the patient has been rewarmed to ≥36°C before evaluating for BD/DNC. (B)
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Avoiding Inaccurate Determination of BD/DNC Caused by Hypotension

Clinicians must ensure that the patient is not hypotensive before performing a BD/DNC evaluation. (A)
Intravenous administration of volume (crystalloid or colloid), with vasopressors or inotropes as needed for management of blood pressure, before and during BD/DNC evaluation, may facilitate this.
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In adults, clinicians should maintain SBP ≥100 mm Hg and mean arterial pressure (MAP) ≥75 mm Hg; and in children, clinicians should maintain SBP and MAP ≥fifth percentile for age. (A)
The same values are applicable for patients supported with venovenous ECMO.
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For adults supported by venoarterial (VA) ECMO, clinicians should target an MAP ≥75 mm Hg; and for children supported by VA ECMO, clinicians should target MAP ≥fifth percentile for age. (A)
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If an individual has a baseline blood pressure that varies significantly from their age-based normal range, clinicians should target an SBP and MAP that approximate the known chronic baseline for that individual patient. (B)
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Avoiding Inaccurate Determination of BD/DNC Caused by Drugs/Medications and Metabolic Derangements

Clinicians must ensure that metabolic derangements, intoxication, and medications that depress the CNS are excluded, adequately corrected, or eliminated before evaluating patients for BD/DNC, as clinically appropriate. Specifically, clinicians must:
  1. Ensure a toxicology (urine and blood) screening result, if clinically indicated, is negative.
  2. Ensure the alcohol blood level, if clinically indicated, is ≤80 mg/dL.
  3. Ensure drug levels for medications that are or may be present and that suppress CNS function, if available, are in the therapeutic or subtherapeutic range and not considered to contribute to the neurologic state. If levels are unavailable:
    • Allow at least 5 half-lives for all CNS-depressing medications or intoxicants to pass and longer if there is renal or hepatic dysfunction or if the patient is obese or was hypothermic (eTable 2, links.lww.com/WNL/D76).
    • Account for age-dependent metabolism of potentially depressing medications in infants and young children and older patients (eTable 2, links.lww.com/WNL/D76).
    • If the patient has received pentobarbital, the level must be <5 μg/mL or below the lower limit of detection for that laboratory before evaluation for BD/DNC.
  4. Exclude severe metabolic, acid-base, and endocrine derangements.
  5. Exclude the effect of pharmacologic paralysis, if administered or suspected, through use of a train-of-four stimulator or demonstration of deep tendon reflexes.
(A)
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If metabolic derangements are unable to be adequately corrected, but the neurologic examination(s) and apnea test(s) are consistent with BD/DNC, the clinician must perform ancillary testing. (A)
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Performing the BD/DNC Neurologic Examination

Before performing a BD/DNC examination, clinicians must review the medical record to determine that the patient has sustained a catastrophic, permanent brain injury with a mechanism of brain injury that is known to lead to BD/DNC and that confounders to the examination have been excluded. (A)
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Clinicians must perform a minimum of 1 examination for BD/DNC. (A)
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In adults, a second clinician may perform a separate and independent examination for BD/DNC. (C)
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In children, 2 clinicians must each perform a separate and independent examination for BD/DNC. In consideration of the stipulated observation period between the 2 examinations in the 1987 and 2011 pediatric guidelines, a minimum interval of 12 hours should separate the 2 examinations. (A)
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When the accurate evaluation of a component of the BD/DNC neurologic examination cannot be assessed safely, clinicians must perform ancillary testing to complete BD/DNC determination. (A)
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All elements of the BD/DNC neurologic examination included here that can be assessed must be assessed, and findings must be consistent with BD/DNC. (A)
If any components of the neurologic examination are inconsistent with BD/DNC, the patient does NOT meet criteria for BD/DNC.
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Components of the BD/DNC Neurologic Examination

Assessment for Unresponsiveness

Clinicians performing the BD/DNC neurologic examination must ensure that the patient is comatose and unresponsive to visual, auditory, and tactile stimulation. Evidence of responsiveness precludes a diagnosis of BD/DNC. (A)
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Assessment for Motor Response

Clinicians performing the BD/DNC neurologic examination must ensure that the patient has no motor responses, other than spinally mediated reflexes, of the head/face, neck, and extremities after application of noxious stimuli to the head/face, trunk, and limbs. (A)
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If it is unclear whether observed limb movements are spinally mediated, determination of BD/DNC should include an ancillary test. (B)
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Assessment of the Pupillary Light Reflex

Clinicians performing BD/DNC neurologic examinations must determine that there are no pupillary responses to bright light bilaterally. (A)
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Assessment of the OCR and the OVR

Clinicians performing the BD/DNC neurologic examinations must determine that there is no OCR unless there is concern for cervical spine or skull base integrity. (A)
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If the OCR is absent bilaterally or if the OCR cannot be tested because of concern for cervical spine or skull base integrity, OVR must be performed bilaterally. (A)
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If the OCR cannot be tested because of concern for cervical spine or skull base integrity, clinicians may diagnose BD/DNC without ancillary testing provided that the OVR can be tested and is absent bilaterally and all other BD/DNC criteria are satisfied. (A)
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Assessment of the Corneal Reflex

Clinicians performing the BD/DNC neurologic examination must determine that there are no corneal reflexes bilaterally. (A)
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Assessment of the Gag and Cough Reflexes

Clinicians performing the BD/DNC neurologic examination must determine that both the gag and cough reflexes are absent. (A)
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Assessment of the Sucking and Rooting Reflexes

In infants younger than 6 months, clinicians performing the BD/DNC neurologic examination must determine that there is no sucking or rooting reflex. (A)
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Apnea Testing as Part of the BD/DNC Evaluation

Number of Apnea Tests Required

Clinicians must perform at least 1 apnea test after the final BD/DNC neurologic examination in adults. (A)
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Clinicians must perform 2 apnea tests in children, 1 after each BD/DNC neurologic examination. (A)
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Procedure for Performing the Apnea Test

Before attempting apnea testing, clinicians must ensure that the patient's risk of cardiopulmonary decompensation during apnea testing is assessed and is acceptable (Level A). Specifically, clinicians must ensure that the patient is not hypoxemic, hypotensive, or hypovolemic before starting the apnea test. (A)
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Clinicians must ensure that patients have normal PaCO2 (35–45 mm Hg) and pH (7.35–7.45) levels before apnea testing, provided the patient is not known to be hypercarbic at baseline. (A)
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If a patient is known to have chronic hypercarbia, and the patient's chronic baseline level is known, the PaCO2 level before apnea testing should be at the patient's chronic baseline level. (B)
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If a patient is known or suspected to have chronic hypercarbia but the patient's chronic baseline PaCO2 level is not known, the PaCO2 level before apnea testing should be at the patient's estimated chronic baseline. However, in this circumstance, if apnea is present, clinicians should perform ancillary testing in addition. (A)
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Clinicians should preoxygenate the patient with 100% oxygen for at least 10 minutes before apnea testing to achieve a PaO2 level >200 mm Hg. (B)
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To allow multiple arterial blood gas (ABG) measurements and reliably monitor the patient's hemodynamic status during apnea testing, clinicians should ensure that the patient has an invasive arterial catheter whenever possible. (A)
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Clinicians should perform ABG measurement after preoxygenation and before disconnecting the ventilator to determine the baseline PaO2, PaCO2, and pH levels. (B)
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Clinicians must ensure adequate oxygenation during apnea testing. In adults, this can be accomplished through (1) stopping intermittent mandatory ventilation and disconnecting the ventilator from the patient's endotracheal tube (ETT)/tracheostomy and delivering 100% oxygen at a rate of 4–6 L/min through a catheter that is <70% of the diameter of the ETT/tracheostomy (to avoid barotrauma), placed inside the ETT/tracheostomy just above the level of the carina; (2) stopping intermittent mandatory ventilation and delivering 100% oxygen through CPAP on the ventilator; or (3) stopping intermittent mandatory ventilation and disconnecting the ventilator from the patient's ETT/tracheostomy and delivering 100% oxygen through a flow-inflating resuscitation bag with a functioning PEEP valve. In children, this can be accomplished through (1) stopping intermittent mandatory ventilation and delivering 100% oxygen through CPAP on the ventilator or (2) stopping intermittent mandatory ventilation and disconnecting the ventilator from the patient's ETT/tracheostomy and delivering 100% oxygen through a flow-inflating resuscitation bag with a functioning PEEP valve. (A)
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Clinicians should perform an ABG measurement after 8–10 minutes of apnea. (A)
The patient may be kept off the ventilator until it is confirmed that the arterial pH and PaCO2 level criteria for BD/DNC determination are met if the patient is hemodynamically stable. Because the physiologic threshold for BD/DNC determination may be reached before 8–10 minutes of apnea, point-of-care blood gas testing may be used to perform ABG measurements earlier and more frequently. If the patient has cardiopulmonary instability, blood gas measurements might be necessary sooner.
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Clinicians must conclude that the apnea test is consistent with BD/DNC criteria if:
  1. In patients who are known NOT TO HAVE chronic CO2 retention, if (1) no respirations occur, (2) the arterial pH level is <7.30, and (3) the PaCO2 level is ≥60 and ≥20 mm Hg above the patient's preapnea test baseline level.
  2. In patients who are KNOWN TO HAVE chronic CO2 retention, and the baseline PaCO2 level is KNOWN, clinicians must conclude that the apnea test is consistent with BD/DNC criteria if (1) no respirations occur, (2) the arterial pH level is <7.30, and (3) the PaCO2 level is ≥60 and ≥20 mm Hg above the patient's known chronic elevated premorbid baseline level.
  3. In patients who are SUSPECTED TO HAVE chronic CO2 retention, but the baseline PaCO2 level is UNKNOWN, clinicians must conclude that the apnea test is consistent with BD/DNC criteria if (1) no respirations occur, (2) the arterial pH level is <7.30, and (3) the PaCO2 level is ≥60 and ≥20 mm Hg above the patient's baseline (pretest) level, AND ancillary testing must be performed.
(A)
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Clinicians must abort apnea testing if the patient takes 1 or more spontaneous respirations because the patient does not meet criteria for BD/DNC. (A)
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Clinicians must abort apnea testing if the patient experiences hemodynamic instability or hypoxemia at any point during the apnea test as identified by:
  • SBP <100 mm Hg or MAP <75 mm Hg in adults or SBP or MAP <fifth percentile for age in children despite titration of vasopressors, inotropes, and/or intravenous fluids, or
  • Progressive decrease in oxygen saturation below 85%, or
  • A cardiac arrhythmia with hemodynamic instability.
(A)
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If the patient develops a decrease in blood pressure or oxygen saturation and the need to abort the apnea test seems imminent, clinicians should obtain an ABG measurement before placing the patient back on the ventilator. (A)
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If the PaCO2 and pH level criteria are not reached, and the patient did not experience hemodynamic instability or hypoxemia during apnea testing, clinicians should either continue the apnea test beyond 10 minutes with ABG measurements checked at least every 2 minutes or if the test was discontinued but the patient was hemodynamically stable and did not desaturate, repeat apnea testing for a longer period after again preoxygenating to a PaO2 level >200 mm Hg and reestablishing normal PaCO2 and pH levels. (A)
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If the patient experienced hypoxemia during apnea testing and the pH and PaCO2 level criteria were not reached, clinicians should either repeat the apnea test using an alternative apneic oxygenation method that maintains functional residual capacity (e.g., CPAP through a flow-inflating resuscitation bag), repeat the apnea test when it can be safely completed, or perform an ancillary test. (A)
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If the patient experienced hypotension during apnea testing and the pH and PaCO2 level criteria were not reached, clinicians should either repeat apnea testing after augmenting the blood pressure, repeat the apnea test when it can be safely completed, or perform an ancillary test. (A)
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If the patient developed a cardiac arrhythmia with hemodynamic instability during apnea testing, and the pH and PaCO2 level criteria were not reached, clinicians should repeat the apnea test when it can be safely completed or perform an ancillary test. (A)
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Procedure for Performing the Apnea Test in Patients on ECMO

Clinicians should adhere to the following protocol for apnea testing on ECMO:
  1. Preoxygenate by using 100% FiO2 on the ventilator and through the membrane lung.
  2. To achieve an adequate increase in PaCO2 level, either titrate exogenous CO2 into the ECMO circuit or adjust the sweep gas flow rate to 0.2–1 L/min.
  3. Sample ABG measurements from both the patient's distal arterial line and the ECMO circuit postoxygenator for patients on VA ECMO. PaCO2 and pH levels from both locations are required to meet BD/DNC criteria for the apnea test to be consistent with BD/DNC. This ensures that, independent of the mixing point, the PaCO2 and pH levels in the cerebral circulation meet BD/DNC criteria. For patients on venovenous ECMO, sample ABG measurements only from the patient's distal arterial line.
  4. Avoid hypotension during apnea testing on ECMO by increasing ECMO flows, intravenous fluid administration, or vasopressor/ionotropic support.
(A)
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Ancillary Testing as Part of the BD/DNC Evaluation

Indications for Ancillary Testing

Clinicians should only perform ancillary testing to assist with the diagnosis of BD/DNC when the BD/DNC neurologic examinations or apnea test cannot be completed or the findings cannot be interpreted adequately. (B)
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Clinicians should use ancillary testing in the following circumstances:
  1. Injuries such as fractures of the cervical spine, skull base, or orbits, severe facial injuries or abnormalities that preclude accurate assessment of any components of the neurologic examination (with the exception of the OCR if untestable due to concern for C-spine or skull base integrity), or injuries to the cervical spinal cord that limit the adequate assessment of extremity movement or spontaneous respirations, or
  2. The inability to perform or complete the apnea test safely because of the patient's risk of cardiopulmonary decompensation or the inability to interpret the PaCO2 levels in a patient with chronic hypercarbia for whom the chronic baseline PaCO2 level is unknown, or
  3. Neurologic examination findings that may be difficult to interpret, such as limb movements that may or may not be spinally mediated, or
  4. Metabolic derangements that are unable to be adequately corrected.
(A)
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Clinicians must not use ancillary tests to assist in the diagnosis of BD/DNC in the setting of hypothermia or high levels of sedating medications or to avoid performing otherwise testable elements of the BD/DNC assessment. (A)
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If ancillary testing is needed to diagnose BD/DNC, before proceeding to an ancillary test, BD/DNC neurologic examination(s) and apnea test(s) still need to be performed to the fullest extent possible, and findings must be consistent with BD/DNC. (A)
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If any findings on the BD/DNC neurologic examination or apnea test are consistent with brain-mediated activity, the patient does not meet criteria for BD/DNC, and ancillary testing must not be performed. (A)
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In patients who meet all clinical criteria for BD/DNC, clinicians should not perform ancillary testing solely because of the presence of an open fontanelle, skull fracture, skull defect (e.g., craniectomy), or CSF diversion device. (B)
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Tests of Electrophysiologic Function: EEG

Clinicians should not use EEGs, AEPs, or SEPs as ancillary tests to assist with the diagnosis of BD/DNC. (B)
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Tests of Cerebral Perfusion: 4-Vessel Catheter Angiography

Clinicians may use conventional 4-vessel catheter angiography as an ancillary test to aid in the diagnosis of BD/DNC. (A)
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Tests of Cerebral Perfusion: Radionuclide Perfusion Scintigraphy

Clinicians may use either SPECT radionuclide perfusion scintigraphy with a blood-brain barrier (BBB)–crossing agent or planar radionuclide angiography, preferably with a BBB-crossing agent or, if necessary, a non–BBB-crossing agent, as an ancillary test to aid in the diagnosis of BD/DNC. (A)
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Tests of Cerebral Perfusion: Transcranial Doppler Ultrasonography

Clinicians may use transcranial doppler ultrasonography in adult patients as an ancillary test to aid in the diagnosis of BD/DNC and should not use transcranial doppler ultrasonography as an ancillary test for children. (A)
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Tests of Cerebral Perfusion: CT and Magnetic Resonance Angiography

Clinicians should not use CT angiography as an ancillary test to aid in the diagnosis of BD/DNC. (A)
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Clinicians should not use MRI or magnetic resonance angiography as an ancillary test to aid in the diagnosis of BD/DNC. (B)
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Special Considerations

Obtaining Consent for BD/DNC Evaluation

Clinicians do not need to obtain consent before an evaluation for BD/DNC unless otherwise stipulated by the institution's policy or state laws or regulations. (A)
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Clinicians planning to evaluate a patient for BD/DNC should make a reasonable attempt to inform the patient's family of the plan to perform a BD/DNC examination. (A)
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Clinicians evaluating a patient for BD/DNC should provide the option for the family to observe the clinical evaluation, including apnea testing (Level B). Clinicians should inform families that patients may have reflexive movements caused by activity from the spinal cord, muscles, or nerves during the BD/DNC evaluation and that these movements do not preclude determination of BD/DNC. (B)
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Time of Death

For patients who meet clinical criteria for BD/DNC, clinicians must assign the time of death as the time during the final apnea test (if more than 1 is performed) that the ABG results are reported and demonstrate that the PaCO2 and pH levels are consistent with BD/DNC criteria. (A)
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For patients in whom an ancillary test is required and performed, clinicians determining BD/DNC must assign the time of death as the time an attending clinician (e.g., nuclear medicine physician or angiographer) documents in the medical record that the ancillary test results are consistent with BD/DNC. (A)
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Organ support may be continued for a period after BD/DNC, the length of which is based on the judgment of the attending clinician of record in accordance with the institution's policy, to provide the family with a reasonable but limited amount of time with the deceased patient before the discontinuation of this support. (B)
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Hospital policies should include consideration of providing a reasonable period to accommodate families after the death of a family member and should provide a process to resolve disagreements when families do not agree with the medical team about initiation of the BD/DNC evaluation and/or termination of organ support after determination of BD/DNC. (B)
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Evaluation of BD/DNC in a Patient Who Is Pregnant

Pregnancy in and of itself is not a contraindication to BD/DNC evaluation. Clinicians should assess and diagnose pregnant persons with catastrophic, permanent brain injuries for BD/DNC. (A)
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After the determination of BD/DNC in a pregnant person, the clinicians providing care, assisted by clinicians knowledgeable in maternal-fetal medicine, child neurology, and neonatology, as needed, should educate and discuss with surrogate decision-makers the risks and benefits to the fetus of continuing maternal organ support. (B)
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Neuroendocrine Function

Clinicians may initiate a BD/DNC evaluation and determine a patient BD/DNC despite evidence of neuroendocrine function. (B)
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Primary Posterior Fossa Injury

To avoid determining BD/DNC in patients with primary posterior fossa injury and retained supratentorial function, clinicians should ensure that the posterior fossa process has also led to catastrophic supratentorial injury as demonstrated on a conventional neuroimaging study before initiating the BD/DNC evaluation. (B)
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Recommendation Grading

Abbreviations

  • AAN: Academy Of Neurology
  • AAP: American Academy Of Pediatrics
  • ABG: Arterial Blood Gas
  • AEP: Auditory Evoked Potential
  • APP: Advanced Practice Provider
  • BBB: Blood-brain Barrier
  • BD/DNC: Brain Death/death By Neurologic Criteria
  • COI: Conflict Of Interest
  • CPAP: Continuous Positive Airway Pressure
  • ECMO: Extracorporeal Membrane Oxygenation
  • ETT: Endotracheal Tube
  • HIBI: Hypoxic-ischemic Brain Injury
  • MAP: Mean Arterial Pressure
  • OCR: Oculocephalic Reflex
  • OVR: Oculovestibular Reflex
  • PEEP: Positive End-expiratory Pressure
  • SBP: Systolic Blood Pressure
  • SCCM: Society Of Critical Care Medicine
  • SEP: Somatosensory Evoked Potential
  • UDDA: Uniform Determination Of Death Act
  • VA: Venoarterial

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.

Overview

Title

Pediatric and Adult Brain Death/Death by Neurologic Criteria

Authoring Organizations

Publication Month/Year

October 11, 2023

Last Updated Month/Year

November 6, 2023

Supplemental Implementation Tools

Document Type

Consensus

Country of Publication

US

Document Objectives

The purpose of this guideline is to update the 2010 American Academy of Neurology (AAN) brain death/death by neurologic criteria (BD/DNC) guideline for adults and the 2011 American Academy of Pediatrics, Child Neurology Society, and Society of Critical Care Medicine guideline for infants and children and to clarify the BD/DNC determination process by integrating guidance for adults and children into a single guideline. Updates in this guideline include guidance related to conducting the BD/DNC evaluation in the context of extracorporeal membrane oxygenation, targeted temperature management, and primary infratentorial injury.

Target Patient Population

Adults and children with suspected brain death

Target Provider Population

Neurologists, surgeons, internists, pediatricians and other hospitalists caring for patients with suspected brain death

Inclusion Criteria

Male, Female, Adolescent, Adult, Child, Infant, Older adult

Health Care Settings

Emergency care, Home health, Hospice, Hospital, Long term care, Medical transportation, Operating and recovery room

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Counseling, Diagnosis, Assessment and screening

Diseases/Conditions (MeSH)

D001926 - Brain Death, D001921 - Brain

Keywords

death, brain death, BD/DNC, neurologic criteria, determination of death

Source Citation

Pediatric and Adult Brain Death/Death by Neurologic Criteria Consensus Guideline
Report of the AAN Guidelines Subcommittee, AAP, CNS, and SCCM
David M. Greer, Matthew P. Kirschen, Ariane Lewis, Gary S. Gronseth, Alexander Rae-Grant, Stephen Ashwal, Maya A. Babu, David F. Bauer, Lori Billinghurst, Amanda Corey, Sonia Partap, Michael A. Rubin, Lori Shutter, Courtney Takahashi, Robert C. Tasker, Panayiotis Nicolaou Varelas, Eelco Wijdicks, Amy Bennett, Scott R. Wessels, John J. Halperin
Neurology Oct 2023, 10.1212/WNL.0000000000207740; DOI: 10.1212/WNL.0000000000207740