An update on brain death criteria: a simple algorithm with complex questions

Brain death criteria have been based on 3 cardinal features throughout history: coma, brainstem areflexia, and apnea, and thus have undergone little change. In 1995, the American Academy of Neurology (AAN) detailed these criteria in a step-by-step fashion that included meeting prerequisites, performing the clinical examination, performing ancillary testing, and documentation. Fifteen years later, many questions still remain regarding the diagnosis of brain death. The Quality Standards Subcommittee of the AAN sought to answer 5 of these outstanding questions. Ultimately, their data supported the utility of the 1995 criteria and warned against the use of new technologies before proper validation. This review briefly tells the story of brain death criteria, making mention of the steps outlined by the AAN in 1995 and discussing the recent evidence released by the Quality Standards Subcommittee in the new 2010 Practice Parameter Update.