Brain death

Mechanical ventilation has made it possible for the heart to continue to beat and perfuse other organs even when the brain is dead. This means that death can be diagnosed in two distinct ways: first, in the traditional manner, as permanent cessation of cardiorespiratory function; and, second, while the patient is ventilated, as brain death (BD). In 1976 the Conference of Medical Royal Colleges and their Faculties in the United Kingdom, in a statement on the diagnosis of BD, recognized the brainstem as the centre of brain activity, without which life was not possible. Brainstem death (BSD) occurs when there is complete, irreversible loss of brainstem function, that is, irreversible loss of the capacity for consciousness, coupled with irreversible loss of the capacity to breathe. In the UK, the terms BD and BSD are used interchangeably and are legally synonymous with somatic death. This chapter covers examination for BSD, complications, diagnosis, investigation, and actions arising after BSD, as well as a definition of BD.