Brain death in three neurosurgical units.

Jennett, Bryan; Gleave, J. R. W.; Wilson, Petra

doi:10.1136/bmj.282.6263.533

Cited by 76 publications

(25 citation statements)

References 22 publications

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“…The occurrence of movements in HBCs sometimes causes confusion among caregivers and family members, who may question the very diagnosis, and ultimately delay organ procurement for transplantation. A patient fulfilling the criteria for BD ultimately succumbs to cardiac arrest, which usually occurs within a few days following the diagnosis 47 . Further confirmatory testing with EEG, evoked potentials, transcranial Doppler, cerebral angiography and technetium-99-m-cerebral gammagraphy may be required to support the diagnosis and provides further evidence for yet undescribed SRMs in BD.…”

Section: Practical Implicationsmentioning

confidence: 99%

Movements in Brain Death: A Systematic Review

Saposnik

Basile

Young

2009

Can. j. neurol. sci.

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Brain death is the irreversible lost of function of the brain including the brainstem. The presence of spontaneous or reflex movements constitutes a challenge for the neurological determination of death. We reviewed historical aspects and practical implications of the presence of spontaneous or reflex movements in individuals with brain death and postulated pathophysiological mechanisms. We identified and reviewed 131 articles on movements in individuals with confirmed diagnosis of brain death using Medline from January 1960 until December 2007, using ‘brain death’ or ‘cerebral death’ and ‘movements’ or ‘spinal reflex’ as search terms. There was no previous systematic review of the literature on this topic. Plantar withdrawal responses, muscle stretch reflexes, abdominal contractions, Lazarus's sign, respiratory-like movements, among others were described. For the most part, these movements have been considered to be spinal reflexes. These movements are present in as many as 40-50% of heart-beating cadavers. Although limited information is available on the determinants and pathophysiological mechanisms of spinal reflexes, clinicians and health care providers should be aware of them and that they do not preclude the diagnosis of brain death or organ transplantation.

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Section: Practical Implicationsmentioning

confidence: 99%

Movements in Brain Death: A Systematic Review

Saposnik

Basile

Young

2009

Can. j. neurol. sci.

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“…Most earlier literature, however, has taught that spontaneous cardiac arrest usually occurs within 24 to 72 hours and always within two weeks [1][2][3][4] after brain death. With current cardiorespiratory support techniques, however, prolonged somatic survival is more common [5], although spontaneous cardiac arrests do occur.…”

Section: Natural Historymentioning

confidence: 97%

“…Spinal cord reflexes are not tested as part of the brain death assessment and are often well preserved [22]. 3. Spontaneous movements and seizures are usually absent [23], although one case of complex movements in a patient with isoelectric EEGs and no blood flow on angiography [24] is reported, and several patients in the collaborative study group [22] had spontaneous movement.…”

Section: General Criteriamentioning

confidence: 99%

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Analytic Reviews : The Diagnosis of Brain Death in the Adult Patient

Powner

1987

J Intensive Care Med

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The biological tenet upon which brain death is founded is absolute. The brain's inability to undergo cellular division ensures that once individual neurons die they cannot be replaced. Extrapolating this to the total brain, once the entire brain is dead no recovery can occur, and the patient's family can be guaranteed of that fact. The clinician, therefore, is faced primarily with a diagnostic challenge in determining that brain death is indeed present. The components, procedures, and limitations of that diagnostic process in the adult patient are the subjects of this discussion. Natural HistoryA controlled trial incorporating a standardized treatment protocol and addressing the issue of cardiovascular survival after brairi death has never been published. Most earlier literature, however, has taught that spontaneous cardiac arrest usually occurs within 24 to 72 hours and always within two weeks [1-4] after brain death. With current cardiorespiratory support techniques, however, prolonged somatic survival is more common [5], although spontaneous cardiac arrests do occur. Early cardiac failure supports the urgency felt by many physicians to proceed quickly with the diagnosis of brain death, especially when organ removal for donation is a factor. _ Brain death, or coma depasse, has generally been defined as the irreversible cessation of the function of all parts of the brain above the foramen magnum. Cerebral death identifies the permanent loss of function of both cerebral hemispheres and is synonymous with neocortical death. Unfortunately, the terms brain death and cerebral death have.been used interchangeably, but they are not synonymous. Brainstem death has been identified primarily in the British literature as a vital component of brain death and also as a recognizable separate entity that may exist without cerebral death [6,7]. The philosophical and moral positions supporting termination of life support and initiation of organ removal when only cerebral or brainstem function has ceased, as proposed by some [8], are not discussed here. This article is based on the generally accepted medical, legal, and sociological definition of brain death as that requiring loss of all components of the brain. The interested reader is referred tQ the several review articles available regarding the ethical and legal issues surrounding this topic [9][10][11].

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“…Support for the Harvard Committee's definition has come from both philosophical perspectives [37] and from the statistic that no instance of patient survival has ever been reported following proper documentation of brain death [38,39]. Most states now have statutes recognizing the concept of brain death but they avoid specifically defining it.…”

Section: Declaration Of Brain Deathmentioning

confidence: 99%

Analytic Reviews : Organ Procurement and Brain Death in Trauma Patients

Mackersie

1989

J Intensive Care Med

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Mackersie RC Organ procurement and brain death in trauma patients. J Intensive Care Med 1989;4:137-148. The success rates and effectiveness of transplantation programs continue to increase, as does the need for cadaveric organs. Increasing organ procurement is a worthwhile goal that can be fully justified on economic, humanistic, and ethical bases. Although a great deal of progress has been made in terms of public and political awareness of organ procurement problems, additional changes and further education will be necessary before the number of cadaveric organs that are needlessly wasted can be reduced.Management of patients with unsurvivable head injuries or patients who are candidates for organ donation is a complex task involving critical care management, the declaration of brain death, and the identification of, and request for, organ donation from next of kin. This process involves the coordinated efforts of neurosurgeons, critical care specialists, social workers, and the transplant team coordinators in organ procurement programs. Patients are best managed in tertiary centers that have staffs with the expertise and interest in performing these tasks. The time to cardiac death in brain-dead patients is frequently short and is hastened by the development of rapidly progressive derangements in gas exchange, fluid and electrolyte homeostasis, temperature regulation, coagulation, and cardiovascular function.Premature death under these circumstances continues to be a major reason for organ-procurement failure. Aggressive monitoring and treatment of the multiple medical problems encountered, however, may reduce the number of patients who die prematurely and thus increase organ procurement rates.Organ transplantation, as a result of immunological and technical advances, is a therapeutically desirable means of managing a variety of acute and chronic organ failure states. Cadaveric renal transplantation has proved to be both cost effective and successful in prolonging the life of chronic dialysis patients [1]. Cardiac transplantation is no longer considered an experimental procedure, and the projected 10-year survival for cardiac transplant recipients is more than 25% [2]. The availability of liver transplantation programs and the projected survival of liver transplant recipients is increasing as well [3].The need for organs far outweighs the current supply [4,5] (Table 1), and potential recipients for hearts and livers often succumb to their underlying disease before organs can be found for them. Donor organ availability is frequently the &dquo;ratelimiting step&dquo; in most transplantation programs and may even be the major determinant in the viabilitv of either a heart or liver transplant program [6].The degree of disparity between organ supply and demand has been addressed by several studies. Bart and colleagues [7] reported a 16.1 % organ retrieval rate on the basis of potential donors identified by review of medical records. They estimated a potential donor rate of 2.3% of all in-hospital deaths in 37 ac...

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Brain death in three neurosurgical units.

Abstract: The validity of clinical criteria for diagnosing brain death has been investigated in three ways. A total of 447 published cases were reviewed. In three neurosurgical units (Cambridge, Glasgow, and

Cited by 76 publications

References 22 publications

Movements in Brain Death: A Systematic Review

Movements in Brain Death: A Systematic Review

Analytic Reviews : The Diagnosis of Brain Death in the Adult Patient

Analytic Reviews : Organ Procurement and Brain Death in Trauma Patients

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