Determination Of Death

Patients may be declared dead by brain death criteria and by cardiopulmonary criteria. Currently, the majority of organ donors (98%) are declared dead by brain death. The definition of brain death was first examined in a report by the Harvard Medical School in 1968 and guidelines later set for brain death determination in 1981 which led to the "Uniform Determination of Death Act." These criteria are shown in Table 5.2.

Brain death occurs when complete and irreversible loss of brain and brain stem function occurs, which presents clinically as complete apnea, brain stem areflexia, and cerebral unresponsiveness. In order to evaluate a patient clinically for brain death, several preconditions must be met. The patient must be on a ventilator in a coma and have a cause for underlying brain damage. Most cases are caused by trauma, subarachnoid hemorrhage, cerebral abscess or tumor, meningitis, encephalitis, or cerebral hypoxia. Reversible causes of brain stem depression such as

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