#braindeath - what to know and how to approach.

Brain death is irreversible and determined by absent motor responses, loss of all brainstem reflexes, and apnea after a CO₂challenge. It is not determined by further waiting. Support measures often fail and the ability to maintain a brain-dead body is "virtually impossible". Brain death is a distinct clinical neurologic state and is different from all other manifestations of acute or prolonged coma, where patients may eventually be able to breathe on their own and when some or all brainstem reflexes are preserved. "In the medical judgment of practicing neurointensivists, neurosurgeons, and all neurologic and neurosurgical societies and academies throughout the world, brain death constitutes death of the person," according to a review done by The Mayo Clinic Physicians.

Standards for determining pediatric brain death were established more than 25 years ago and have been adopted and revisited by the Society of Critical Care Medicine, the American Academy of Pediatrics, and the Child Neurology Society. The diagnosis, in a guideline released in 2011, requires 2 examinations, 12 hours apart, by 2 different attending physicians in children 1 year or older. Adult brain death diagnosis, on the other hand, requires just 1 full examination, with optional confirmation by another physician.

Many patients, family members, and the public at large remain confused about the differences between brain death (death) and other neurologic disorders such as coma or persistent vegetative state. It must be emphasized, however, that there is a strong consensus about brain death as a result of decades of discussion in medicine, law, and ethics. All our colleagues in critical care, neurosciences, and biomedical ethics should be encouraged to engage patients and local communities about matters related to brain death.

On the other hand, the reality of brain death can be very difficult for families to accept. There are counterintuitive aspects to brain death because the patient's heart is still beating, blood is circulating. Patients do not look like they are dead in terms of the traditional understanding of what a dead body looks like. That is one factor that can make brain death hard to understand. Besides, there is confusion about the term 'brain death. Many people confuse it with coma and they have read newspaper accounts of people believed to be in an irreversible coma who recover, and that adds to the scepticism or gives them hope that their loved one will simply recover. That does not happen if the diagnosis of brain death has been made accurately.

Explaining that a loved one is brain dead to a family can be difficult and requires sensitivity and compassion on the part of the health professional delivering the news. Maybe, a more appropriate term for brain death would be "death determined by the absence of brain function". The points that need to be communicated are that it's hopeless, irreversible, and that there is no benefit for any type of treatment. It's accepted as death in the law and it offers an opportunity for organ donation.