Brain death

With the introduction of mechanical ventilation, patients suffering neurological catastrophes who previously would have perished are now often systemically supported, thereby bringing the concept of brain death into existence. Brain death is defined as the irreversible loss of the clinical function of the entire brain, including the brainstem, and may result from a number of causes. The correct diagnosis of brain death is essential from several standpoints: to ensure that unnecessary treatments and procedures are not performed, to provide a sense of finality for families concerned about prognosis, to preserve vital critical care resources, and to allow for the possibility of organ donation. The concept of brain death is accepted in most countries and cultures, but ethical arguments remain regarding certain concepts, such as the concept of isolated brainstem death or higher-brain death. This review will assist the clinician in understanding the concepts behind brain death, the proper technique for determination, and the areas of controversies that remain.