Determination of brain death.

With the careful application of the principles outlined herein, brain death can be determined with certainty. There have been no documented reports of survivors when these guidelines have been followed. The traid of a known mechanism of brain injury, absence of contributing metabolic or toxic central nervous system depression and absence of demonstrable brain function is sufficient to determine brain death clinically and, in most states, legally. The use of apneic oxygenation protects cadaver organs for transplantation during the period needed to prove that a patient cannot breathe. Very little can ameliorate the tragedy of sudden and unexpected fatal cerebral injury. Nonetheless, the concept of brain death is well established, and there is no longer a medical or an ethical reason to prolong unnecessary support of these patients.