New consensus practice guidelines for the clinical determination of brain death/death by neurologic criteria (BD/DNC) have been published in the online version of the journal Neurology. The new guidelines are intended to provide clinicians with standardized procedures for determining BD/DNC in both pediatric and adult patients. Instead of the traditional term “brain death”, the panel of experts from multiple medical societies who developed the guidelines selected the term “brain death/death by neurologic criteria” as a more accurate categorization to describe the state of total, irreversible loss of function in the brain and brainstem following catastrophic brain injury.

The guidelines are intended to enhance clinical evaluation of brain death by:

• Outlining a procedure for detecting independent breathing and clinical function in the brain and brainstem for a patient with suspected brain death
• Updating prerequisite conditions necessary for making a determination of BD/DNC
• Updating requirements for the examiners and examination involved in apnea and ancillary testing
• Providing clinicians with a digital application that provides assistance throughout the process of brain death determination
• Combining previously disparate guidance for pediatric and adult patients into a single set of standardized procedures for patients of all ages

The guidelines were developed using an evidence-informed consensus process funded by the American Academy of Neurology (AAN), and carried out in collaboration with representatives from the following medical societies:

• The American Academy of Pediatrics (AAP)
• The Child Neurology Society (CNS)
• The Society of Critical Care Medicine (SCCM)

The newly developed guidelines serve as an update to the 2010 AAN adult practice guidelines and the 2011 AAP/CNS/SCCM pediatric practice guidelines.

"Right now, brain death determination policies vary among hospitals across the U.S. and worldwide, and a standardized approach is necessary," said author Ariane Lewis, MD, FAAN, of NYU Langone Medical Center in New York City. "This guideline provides a highly rigorous and structured approach to brain death evaluation and determination. It is recommended that hospital administrators ensure that their hospital's brain death determination policies are updated to be consistent with this new guideline."