Brain Death Documentation: Analysis and Issues

To the Editor:

Not in the article by Wang et al. (2), with its extensive bibliography, nor in Dr. Goodman's lucid and detailed letter (1), with his bibliography, nor in my own literature search have I ever found any mention or discussion of a brain death determination method that we—as well as, I suspect, the majority of neurosurgeons—have commonly applied during the past 25 years or so, with uniform accuracy, and with a high rate of organ retrieval: the demonstration of absent cerebral blood flow by means of intracranial pressure monitor measurement, as follows: cerebral perfusion pressure = mean arterial pressure − intracranial pressure. The mode of monitoring is immaterial, whether by extradural or parenchymal transducers or by ventricular catheter, provided that management is performed according to standard neurosurgical protocols in an intensive care environment.

If the accepted criteria for brain death are satisfied, including appropriate cause, deep coma, absent brainstem reflexes, apnea as tested in the standard fashion, and any “confirmatory test” that may be thought necessary (including Dr. Goodman's highly accurate isotope angiography by means of ⁹⁹Tc-hexamethypropylene amine oxime), absence of cerebral blood flow by using intracranial pressure monitor data can be used (usually as the only confirmatory test) to clinch the diagnosis, to provide closure for the family, and to prepare for organ procurement.

1.

Goodman JM: Brain death documentation: Analysis and issues. Neurosurgery 52: 1242–1243, 2003 (letter).

2.

Wang MY, Wallace P, Gruen JP: Brain death documentation: Analysis and issues. Neurosurgery 51: 731–736, 2002.