Education Corner – Brain Death Declaration

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Brain Death Declaration: A Nursing Perspective

Definition of Brain Death

  • Harvard ad hoc group defined cerebral/brain death in 1968.
  • Uniform Determination of Death Act (1980):

UDDA_1980

  • Brain death is a final diagnosis. According to the American Academy of Neuro-logy (AAN), no recovery of neurologic function has been reported in adults who received the clinical diagnosis of brain death following the 1995 AAN criteria.

Conditions Mimicking Brain Death

It is important to follow the AAN guidelines for diagnosing brain death in order to rule out conditions that can mimic brain death. For example:

ConditionsBD

Brain Death Testing

The linked article from the AAN in the reference section outlines in detail evidence-based guidelines for determining brain death in adults. Included in the article is an appendix with a recommended brain death declaration checklist.

Confirmatory Testing

Confirmatory tests are recommended when there is uncertainty or unreliability in the neurological examination or when the apnea test cannot be performed, according to the AAN. Confirmatory tests may include tests such as cerebral angio-graphy, electroencephalography, transcranial doppler ultrasonography, and cerebral blood flow studies.

Communicating with Families

Communication and support throughout the patients course of care is vitally important. Conveying this devastating diagnosis will be difficult unless a trusting relationship has been developed. The clinical team should always be aware of language that will confuse.
Once a patient has been declared brain dead, avoid conflicting language e.g.

FamilyLanguage

Documentation

Clear documentation of brain death testing and a clear commitment to the brain death diagnosis when clinically determined, is necessary for effective communication to the family and to minimize doubt to a third party.
Ensure all testing and documentation is in alignment with hospital policy and state law requirements, while also following the recommended guidelines by the AAN.

 

AAN Reference:
Wijdicks E.F.M., et al.  (2010). Evidence-based guideline update: Determining brain death in adults. Neurology 74: 1911-1918. download

Other References:
Uniform Determination of Death Act, 1980, link

Brain Death Toolkit
More resources and a link to the Brain Death toolkit hosted on the AAN website can be located in the Organ Donation Toolbox “Neurological Determination of Death” section. 

Taken from a webinar presentation by Mary M. Guanci, MSN, RN, CNRN, SCRN, Clinical Nurse Specialist, Neuroscience ICU, Massachusetts General Hospital, Boston, MA. An OnDemand version of the webinar is available through the Alliance Academy.

A special thanks to Mary for her contributions in this inservice.

Editor: Hedi Aguiar RN, MSN, Director of Programs and Communications, The Alliance, haguiar@odt-alliance.org.
This Education Corner is available for downloadThe Alliance grants permission for the distribution and reproduction of this educational communication.

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