The World Brain Death Project has released recommendations regarding the minimum clinical criteria needed to determine brain death/death by neurologic criteria (BD/DNC) in various scenarios.
The recommendations, which were developed by an international, multidisciplinary panel of experts, include:
A neurologic diagnosis that can cause complete and irreversible loss of all brain function should be established prior to examining a patient for BD/DNC. Clinicians should rule out any conditions that could confound clinical examination and any diseases that may resemble BD/DNC.
A clinical examination demonstrating coma, brainstem areflexia, and apnea can determine BD/DNC, which occurs when:
There are no signs of arousal or awareness to maximal external stimulation, including noxious visual, auditory, and tactile stimulation.
Pupils remain fixed in a midsize or dilated position and do not react to light.
There are no corneal, oculocephalic, and oculovestibular reflexes.
No facial movement to noxious stimulation occurs.
The gag reflex does not respond to bilateral posterior pharyngeal stimulation.
The cough reflex does not respond to deep tracheal suctioning.
A brain-mediated motor response to noxious stimulation of the limbs does not occur.
Spontaneous respirations do not occur when apnea test targets reach a pH of less than 7.30 and partial pressure of carbon dioxide of at least 60 mm Hg.
Ancillary testing with blood flow studies or electrophysiologic testing may be considered if the clinical examination is unable to be completed.
Special considerations are required in certain patients, including children, individuals receiving extracorporeal membrane oxygenation, and individuals receiving therapeutic hypothermia.
Other factors such as religious, societal, and cultural perspectives; legal requirements; and resource availability should also be taken into account.