Accepted Medical Standards for Brain Death
| Standard | ||
| Parameter | American Academy of Pediatrics (18,46) | American Academy of Neurology (17,45) |
| Relevant age | 37 wk gestation to 18 y | >18 y |
| Prerequisites | Known irreversible cause of coma | Known irreversible cause of coma |
| No hypothermia or hypotension | Normal temperature or mild hypothermia; systolic blood pressure ≥ 100 mm Hg | |
| No metabolic disturbances | No severe electrolyte, acid–base, or endocrine disturbance | |
| Sedatives, analgesics, neuromuscular blockers, and anticonvulsant agents discontinued | Absence of CNS-depressant drug effect; no evidence of residual paralytics | |
| Defer examination for 24–48 h after acute brain injury | Wait several hours since onset of brain insult to exclude possibility of recovery | |
| Performed by… | Attending physicians involved in care of child | Physician demonstrating competence and intimate familiarity with protocol |
| Cardinal findings | Coma; lack of all responsiveness; absence of eye movement or motor response to noxious stimuli | Coma; absence of motor response to noxious limb stimuli (other than spinally mediated reflexes) |
| Loss of all brain stem reflexes (mid- or fully dilated pupils unresponsive to light; corneal, oculovestibular, gag, sucking, and facial movement to noxious stimuli) | Loss of brain stem reflexes (pupillary response to light; corneal, oculoencephalic, oculovestibular, gag, cough, and facial movement to noxious stimuli) | |
| Apnea test (safety permitting) | Apnea testing (as mandated) | |
| Flaccid tone and absence of movement | ||
| Recommended confirmatory or ancillary studies | 4-vessel angiography | Cerebral angiography |
| Electroencephalogram | Electroencephalogram | |
| Radionuclide cerebral blood flow | Cerebral scintigraphy (99mTc-HMPAO) | |
| Transcranial Doppler ultrasonography | ||
| Indication for confirmatory studies | If components of examination cannot be safely performed | When uncertainty exists about reliability of parts of neurologic examination |
| If apnea testing cannot be safely performed | When apnea test cannot be performed | |
| To reduce interexamination observation period | To shorten duration of observation period | |
| If uncertain neurologic examination result is present | ||
| If uncertain medication effect is present | ||
| If helpful for social reasons, allowing family members to better comprehend diagnosis | ||
| Requirement for repeat physical examinations | Two examinations by different physicians separated by observation period; apnea testing may be repeated by same physician | One neurologic examination is sufficient (some U.S. state statutes require two examinations) |
| Observation period between repeat examinations | 24 h for term newborns (37 wk gestation to 30 d); 12 h for infants and children (>30 d to 18 y) | Not required |
CNS = central nervous system.