Clinical Prerequisites and Findings (2)
Parameter | Finding |
---|---|
Clinical prerequisites | Clinical or neurologic evidence of acute central nervous system catastrophe compatible with diagnosis of brain death, with known or proximate cause of brain death identified |
Exclusion of confounding variables such as severe electrolyte, metabolic, endocrine, or circulatory disturbance | |
No presence of drug intoxication or poisoning that could confound clinical assessment, including any sedative drugs administered by clinicians | |
Core temperature maintained above 36°C (97°F), as hypothermia may suppress brain function, potentially leading to inaccurate clinical determination | |
Systolic blood pressure maintained above 100 mg Hg and mean arterial pressure of at least 75 mm Hg for adults; in children, systolic blood pressure and mean arterial pressure should be at or above fifth percentile for age; administration of vasopressors may be needed to achieve this level | |
Clinical findings | Coma |
Absence of brain-originating motor response, including response to pain stimulus above neck or other brain-originating movements | |
Absence of reflexes, including pupillary light, corneal, gag, oculocephalic (doll’s eyes), and oculovestibular reflexes (caloric responses) | |
Absence of jaw jerk | |
Absence of cough with tracheal suctioning | |
Absence of sucking or rooting reflexes (in neonates) | |
Apnea as demonstrated by apnea test | |
Observation period | Minimum of 6 h; longer periods recommended in children and for certain conditions such as after cardiopulmonary resuscitation or other severe acute brain injuries |