Defining Brain Death: Medical Groups Set New Guideline to Standardize Evaluation

The new brain death guidelines for adults and children become the first update on the standard in over a decade. A group of 20 experts from various medical specialties, organizations, and societies developed the revised consensus practice guideline, also known as death by neurologic criteria (BD/DNC).

The Child Neurology Society (CNS), the American Academy of Pediatrics (AAP), the American Academy of Neurology (AAN), and the Society of Critical Care Medicine (SCCM) collaborated to create the new brain death guidelines.

The updated brain death guidelines state that brain death should be declared when a patient with a known cause of catastrophic brain injury has permanent brain and brainstem function loss that causes coma, brainstem areflexia, and apnea with an adequate stimulus.

The revised guidelines on brain death make apnea testing and neurological tests more clear. They also shed light on pre-evaluation blood pressure and body temperature objectives and brain death evaluation in pregnant, extracorporeal membrane-oxygenated, or basic brain damage patients.

For the first time, the guideline states that medical professionals should not require consent before brain death examinations unless institutional policy, state laws, or regulations stipulate otherwise.

Updated Brain Death Guideline as 'Standard of Care' in the US

Dr. Matthew Kirschen, a critical care physician at Children's Hospital of Philadelphia, stressed the update's importance by combining adult and kid counseling into one standard, which will allow physicians to assess catastrophic brain injury patients for brain death.

"This update integrates guidance for adults and children into a single guideline, providing clinicians with a comprehensive and practical way to evaluate someone who has sustained a catastrophic brain injury to determine if they meet the criteria for brain death," he said, as quoted by US News & World Report.

Each institution in the US is responsible for its own brain death determination policy, per the new guideline. Dr. David Greer, chair and chief of neurology at Boston University School of Medicine, expects that this new national standard will spur swift adjustments in line with the current recommendations.

"The 2023 guidelines will be considered the standard of care in the US," Greer, who led the study, noted, as quoted by Medscape.

Following severe brain damage, brain death is characterized by a full and irreversible termination of brain function. As opposed to comatose and vegetative states, brain death is a legal pronouncement of death since victims do not recover.

Technology to Determine Brain Death Made More Accessible

These revised guidelines are intended to give medical professionals a consistent method for clinically assessing brain and brainstem function. The authors urge that hospital managers adjust their brain death determination procedures to comply with these new standards as US and global policies differ.

A computerized tool is now freely accessible on the AAN website to aid doctors in the process of determining brain death.

Moreover, when determining brain death in children, the guidelines also advise taking extra care and patience. According to USA Today, the updated brain death guidelines direct doctors to conduct two independent exams at least 12 hours apart for young patients, as opposed to the normal single evaluation that adults undertake to determine brain death.

The importance of this prolonged evaluation time can be attributed to children's growing brains' higher resilience. Due to the difficulties in determining small brains and bodies, the updated brain death guidelines specifically specify that babies born before 37 weeks cannot be labeled as brain dead.