Death by neurologic criteria: pathophysiology, definition, diagnostic criteria and tests

Robba, Chiara; Iaquaniello, Carolina; Citerio, Giuseppe

doi:10.23736/s0375-9393.19.13338-x

Cited by 8 publications

(8 citation statements)

References 47 publications

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“…Regardless of the mechanism, the ischemia inherent to BD induces a number of hormonal, metabolic, and hemodynamic changes. The pontine ischemia causes vagal and sympathetic stimulation, which are manifested as bradycardia, hypertension, and an irregular breathing pattern (known as the “Cushing triad”) that evolves to apnea [ 26 ]. The ischemia affects the pituitary, hypothalamic, and medulla oblongata, resulting in failure of the central regulatory systems, unopposed sympathetic stimulation, loss of spinal sympathetic pathways, and following sympathetic denervation [ 21 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

“…This process causes a huge rise in the catecholamine release into the circulation (known as the “sympathetic storm”): the serum dopamine concentration increases in 800%; the epinephrine in 700%; and the norepinephrine in 100%. The sympathetic storm induces severe vasoconstriction, and consequent hypertension, tachycardia, and increased myocardial oxygen demand [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…After BD, a range of dysfunctions and physiologic alterations in many systems occurs, including cardiovascular (hypotension, arrhythmias) [ 21 ], pulmonary (pulmonary edema, ventilator-induced lung injury) [ 21 ], thermoregulatory (hypothermia) [ 21 ], endocrine (diabetes insipidus, hypoglycemia) [ 28 ], renal (acute injury), and hematologic (disseminated intravascular coagulation) [ 21 , 26 ]. Additionally, an important systemic inflammatory response occurs due to the upregulation of pro-inflammatory mediators, which may jeopardize the graft survival after transplantation [ 21 , 29 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

“…The ischemic tissue evolves with edema and brain swelling, increasing the ICP. The following steps of this process are described above [ 26 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

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Brain death and management of the potential donor

et al. 2021

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One of the first attempts to define brain death (BD) dates from 1963, and since then, the diagnosis criteria of that entity have evolved. In spite of the publication of practice parameters and evidence-based guidelines, BD is still causing concern and controversies in the society. The difficulties in determining brain death and making it understood by family members not only endorse futile therapies and increase health care costs, but also hinder the organ transplantation process. This review aims to give an overview about the definition of BD, causes, physiopathology, diagnosis criteria, and management of the potential brain-dead donor. It is important to note that the BD determination criteria detailed here follow the AAN’s recommendations, but the standard practice for BD diagnosis varies from one country to another.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…The ischemic tissue evolves with edema and brain swelling, increasing the ICP. The following steps of this process are described above [ 26 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

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Brain death and management of the potential donor

et al. 2021

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“…These changes threaten the viability of organs for transplantation, with up to 20% of potentially transplantable organs being lost because the clinical management is challenging [49,50]. Donor optimisation needs to be timely and aggressive to reduce the adverse effects of an increasingly older, more obese and more co-morbid donor pool on transplant outcomes [51].…”

Section: Optimisation Of the Potential Dbd Donormentioning

confidence: 99%

Current status of organ donation after brain death in the UK

Manara

Thomas

2020

Anaesthesia

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Organ donation after brain death remains the deceased organ donation pathway of choice. In the UK, the current identification and referral rate for potential donation after brain death donors is 99%, the testing rate for determining death using neurological criteria is 86% and the approach to families for donation is 91%. Increasing donation after brain death donation will primarily require a large increase in the current consent rate of 72% to one matching the consent rate of 80-90% achieved in other European countries. Implementing the use of evidence-based donor optimisation bundles may increase the number of organs available for transplantation. Alternatively, the UK will need to look at more challenging ways of increasing the pool of potential donors after brain death. The first would be to delay the withdrawal of life-sustaining treatment in patients with devastating brain injury to allow progression to brain death after the family have given consent to organ donation and with their consent to this delay. Even more challenging would be the consideration of reintroducing intensive care to facilitate organ donation programmes that have been so successful at increasing the number of organ donors elsewhere.

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The Minimal, Intermediate, and Advanced Skills: How to Boost Your Competencies

Rasulo

Zugni

2020

Echography and Doppler of the Brain

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Death by neurologic criteria: pathophysiology, definition, diagnostic criteria and tests

Cited by 8 publications

References 47 publications

Brain death and management of the potential donor

Brain death and management of the potential donor

Current status of organ donation after brain death in the UK

The Minimal, Intermediate, and Advanced Skills: How to Boost Your Competencies

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