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Brainstem or entire brain-based declaration of death: is there a difference?
  1. Panayiotis N Varelas
  1. Correspondence to Dr Panayiotis N Varelas, Departments of Neurology and Neurosurgery, Henry Ford Hospital, K-11, 2799 West Grand Blvd, Detroit MI 48202, USA; varelas{at}neuro.hfh.edu

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In this issue of Practical Neurology, Cameron et al, review in detail the confirmation of brainstem death process in the UK. The diagnosis of non-cardiorespiratory death is defined as irreversible cessation of all brainstem function, and, with certain caveats as described in the Academy of Medical Royal Colleges1; this is considered to be death. The assessment is based on: (1) the identification of a cause for irreversible brainstem function loss, (2) exclusion of potential confounders, (3) testing of brainstem reflexes as a proxy for residual brainstem function and (4) completion of the apnoea test. In cases where there is any doubt about the diagnosis or parts of the evaluation cannot be completed, ancillary tests are also performed.

In the USA, the definition is that the entire brain function should have irreversibly ceased rather than just that of the brainstem. In most states, brain death is determined according to ‘accepted medical standards’, which …

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