Brain death (or brainstem death in the UK) is an uncommon result of a major catastrophic neurologic injury. The determination of brain death proceeds through a comprehensive and stepwise evaluation. There is no room for misinterpretations. Slip ups, however, could occur with brain death determination and this review discusses the most common concerns encountered by physicians. Problems may arise when a multitude of small errors accumulate and this may occur with an inexperienced physician who misjudges confounders, performs an incomplete evaluation, and misinterprets a confirmatory test.