Inconsistencies Between the Criterion and Tests for Brain Death.

Area of Science:

• Neurology
• Medical Ethics
• Forensic Medicine

Background:

• The whole-brain criterion defines death as irreversible loss of all brain functions.
• Bedside brain death (BD) tests are used to clinically determine fulfillment of this criterion.
• Potential discrepancies between clinical tests and the definition of brain death exist.

Purpose of the Study:

• To analyze case reports of mismatches between bedside brain death tests and the whole-brain criterion of death.
• To explore potential resolutions for identified discrepancies in diagnosing brain death.
• To advocate for improvements in brain death testing protocols.

Main Methods:

• A nonsystematic literature review of case reports was conducted.
• Analysis focused on instances where bedside BD tests conflicted with the whole-brain criterion.
• Identified cases involved retained neurological functions, uncertain neurological signs, or inconsistencies between standard and ancillary BD tests.

Main Results:

• Case reports revealed patients diagnosed with BD exhibited signs of retained brain function.
• Some cases showed neurological signs of unclear origin, challenging BD diagnosis.
• Inconsistencies were found between standard BD tests and ancillary tests, such as those assessing intracranial blood flow.

Conclusions:

• Two approaches can resolve mismatches: loosening the whole-brain criterion or tightening BD tests.
• Given the ambiguity in defining necessary brain functions, tightening BD tests is recommended.
• Requiring proof of absent intracranial blood flow is proposed as a more reliable ancillary test for BD diagnosis.