Redrawing the line between life and brain death

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Credit: V. Raju

Brain death has been a recognized concept in medicine for decades. But there’s a lot of variation in how people define it, says Gene Sung, a neurocritical care physician at the University of Southern California in Los Angeles. “Showing that there is some worldwide consensus, understanding and agreement at this time will hopefully help minimize misunderstanding of what brain death is,” Sung says.

As part of the World Brain Death Project, Sung and his colleagues convened doctors from professional societies around the world to forge a consensus on how to identify brain death. This group, including experts in critical care, neurology and neurosurgery, reviewed the existing research on brain death (which was slim) and used their clinical expertise to write the recommendations, published August 3 in JAMA. In addition to the main guidelines, the final product included 17 supplements that address legal and religious aspects, provide checklists and flowcharts, and even trace the history of relevant medical advances. “Basically, we wrote a book,” Sung says.

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A brain death assessment ought to include a series of tests for physical responses that require a functional brain: eye movement, pain responses and gag responses, among others. Physicians also ought to see whether a person attempts to breathe independently, a life-sustaining process that relies on the brain stem. If none of these signs are present, a person could be considered brain-dead.

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