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When are ancillary tests recommended in brain death confirmation?

Abstract:

It is widely accepted that brain death (BD) is a clinical diagnosis, although ancillary tests are recommended when specific components of the clinical testing cannot reliably be evaluated. The therapeutic use of barbiturates in patients with severe intracranial hypertension or other forms of drug intoxication, hypothermia, and other metabolic disturbances, can prevent determination of BD by clinical criteria. We present a review here about the use of ancillary tests in BD confirmation. Confirmatory tests in BD can be divided in those proving absent cerebral blood flow (CBF) and those that demonstrate loss of bioelectrical activity. We recommend assessing circulatory arrest by transcranial Doppler (TCD), and neuronal function by a neurophysiologic test battery. If TCD fails to validate the absence of CBF, computer tomography angiography can be used to confirm BD diagnosis. © Internet Scientific Publications, LLC., 1996 to 2010.