[Communication with the relatives of a patient presumed brain dead]

The choice of wording in cases of suspected brain death is important. If brain death has not been proven by electrocerebral silence and by absence of spontaneous breathing in an apnoea test in a patient in intensive care, then words like 'brain dead', 'has died' and 'clinical brain death' should be avoided in conversations with the relatives of the patient. This is illustrated by three cases.

The first patient was a 46-year-old woman, with thrombosis of the basilar artery; the second was a 26-year-old man who was resuscitated after a bilateral pneumothorax, but developed severe postanoxic encephalopathy; and the third patient was a 64-year-old man with a large intracerebral haemorrhage. The relatives were informed that the patient was 'brain dead' or 'deceased' based on loss of consciousness (Glasgow Coma score of 3) and absence of brain stem reflexes, but prior to the completion of the brain death protocol by electroencephalography and apnoea testing. In the first and third cases, brain death could not be proven, and the pronouncement that the patient was deceased had to be reversed. The emotional relatives refused organ donation. In the second case, death was pronounced upon loss of consciousness and absence of brain stem reflexes. The relatives refused organ donation, after which mechanical ventilation was withdrawn and the patient was declared dead for a second time based on circulatory arrest.

A patient is dead after complete brain death determination or after circulatory arrest. Loss of consciousness (Glasgow Coma score of 3) and absence of brain stem reflexes lead to a state of catastrophic cerebral damage, but not to brain death. In such a situation, wording such as 'brain death', 'deceased' and 'clinical brain death' should be avoided in conversations with the relatives.