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Pediatric and Adult Brain Death/Death by Neurologic Criteria Consensus Guideline
David M Greer1, Matthew P Kirschen1, Ariane Lewis1
1From the Department of Neurology (D.M.G., C.T.), Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, MA; Departments of Anesthesiology and Critical Care Medicine, Neurology, and Pediatrics (M.P.K.), Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania; Departments of Neurology and Neurosurgery (A.L.), NYU Langone Medical Center, New York City; Department of Neurology (G.S.G.), University of Kansas Medical Center, Kansas City; Department of Neurology (A.R.-G.), Cleveland Clinic Lerner College of Medicine of the Case Western Reserve University, OH; Departments of Pediatrics and Neurology (S.A.), Loma Linda University School of Medicine, CA; Surgical Affiliates Management Group (M.A.B.), Grand Forks, ND; Department of Neurosurgery (D.F.B.), Baylor College of Medicine, Texas Children's Hospital, Houston; Department of Neurology (L.B.), University of Pennsylvania, Philadelphia; Atlanta VA Medical Center and Department of Radiology and Imaging Science (A.C.), Emory University, GA; Departments of Neurology and Pediatrics (S.P.), Stanford University, Palo Alto, CA; Department of Neurology (M.A.R.), University of Texas Southwestern Medical Center, Dallas; Departments of Critical Care Medicine, Neurology, and Neurosurgery (L.S.), University of Pittsburgh, PA; Department of Anesthesia (R.C.T.), Boston Children's Hospital, MA; Department of Neurology (P.N.V.), Albany Medical College, NY; Department of Neurology (E.W.), Mayo Clinic, Rochester, MN; American Academy of Neurology (A.B., S.R.W.), Minneapolis, MN; and Department of Neurosciences (J.J.H.), Overlook Medical Center, Summit, NJ.
This updated guideline provides comprehensive recommendations for determining brain death/death by neurologic criteria (BD/DNC) in both adults and children. It integrates current evidence and special considerations for accurate BD/DNC evaluations.
Area of Science:
- Neurology
- Critical Care Medicine
- Pediatrics
Background:
- Existing guidelines for brain death/death by neurologic criteria (BD/DNC) in adults (2010) and children (2011) have been updated.
- This revision aims to unify guidance for all age groups into a single, comprehensive guideline.
Purpose of the Study:
- To update and integrate existing guidelines for brain death/death by neurologic criteria (BD/DNC) determination for adults and children.
- To provide a single, unified guideline for BD/DNC evaluation.
- To incorporate new guidance on specific clinical contexts such as ECMO, targeted temperature management, and primary infratentorial injury.
Main Methods:
- An expert panel from multiple medical societies developed recommendations.
- A novel, evidence-informed formal consensus process was employed due to limited high-quality evidence.
- Recommendations were formulated and voted on using a modified Delphi process, adhering to the 2017 AAN Clinical Practice Guideline Process Manual.
Main Results:
- Eighty-five recommendations were developed.
- Recommendations cover general principles, qualifications, prerequisites, neurologic examination components, apnea testing, ancillary testing, and special considerations for BD/DNC determination.
Conclusions:
- The updated guideline offers a unified approach to BD/DNC determination across all ages.
- It addresses critical updates for specific clinical scenarios.
- The guideline provides a robust framework for accurate and consistent BD/DNC evaluations.

