The concept and understanding of brain death have evolved significantly over the past few decades. This entity has become more recognized as our ability to provide prolonged cardiovascular support to brain injured patients became more sophisticated. In parallel with these developments, organ transplantation became a reality with wider applications resulting in significant increase in demand for potentially transplantable organs. Quite likely, the availability of organs for transplantation was fueled by the broadened application of brain death laws. Achieving a uniform definition of brain death and establishing methods for prompt brain death diagnosis (prior to the onset of hemodynamic and cardiovascular collapse) is a sine qua non in the field of modern organ transplantation. Therefore, it was of great importance to achieve a uniform definition of brain death and establish methods for prompt diagnosis prior to the development of hemodynamic instability which culminates in cardiovascular collapse.
The concept of brain death is confusing for many in the medical community as well as in the lay public. The purpose of this chapter is to outline the legislative and clinical background of current definitions, describe a systematic process for the evaluation of the brain injured patient, and to arrive at the diagnosis of brain death.
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