TABLE 1.

Clinical Prerequisites and Findings (2)

ParameterFinding
Clinical prerequisitesClinical 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 findingsComa
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 periodMinimum of 6 h; longer periods recommended in children and for certain conditions such as after cardiopulmonary resuscitation or other severe acute brain injuries