Determination of Brain Death

I wonder what the explanation is used on death certificates for people dying from stroke effects. People do not die from the stroke, they die from brain damage. Until this reporting is changed we never will be able to determine the reason for dying. Stoke is way too simplistic and uninformative. We used to have the category of dying from old age, that was eliminated because it told us nothing useful.

Determination of Brain Death

• David M. Greer, M.D.

The determination of brain death is typically made on the basis of clinical assessment (shown in a video) and requires demonstration of the permanent loss of all brain function, including brainstem function, in the absence of factors that may confound the assessment. If these factors cannot be eliminated, or if the examination cannot be safely or fully performed, ancillary testing is conducted.

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Disclosure forms provided by the author are available with the full text of this article at NEJM.org.

The author thanks Dr. Rafael Ortega for his assistance with the videos of the examination for the determination of brain death.

Author Affiliations

From the Boston University School of Medicine and Boston Medical Center — both in Boston.

Dr. Greer can be contacted at dgreer@bu.edu or the Department of Neurology, 85 East Concord St., Rm. 1145, Boston, MA 02118.