Brain Death Testing

Brain, Spine & Nerves · ICU Decoded chapter 34 · Locked — free with a referral

By Dr Javed Akhtar · Last reviewed 3 October 2026

Cited to AAN DNC 2023 · local certification law.

Key points

Before adult DNC testing, establish a permanent catastrophic brain injury and complete the observation period; core temperature must be ≥36 °C. Exclude drug effects, paralysis and severe metabolic confounders.
Adult DNC needs coma, absent brainstem reflexes and no breathing effort during an adequate apnea test: arterial pH <7.30, PaCO₂ ≥60 mm Hg AND ≥20 mm Hg above baseline.
If the exam stays incomplete, add a blood-flow ancillary test (4-vessel angiography, radionuclide perfusion, or TCD in adults); EEG and CT angiography are not accepted (AAN 2023).
Involve organ procurement early; good donor management preserves options for families.

Investigations

First tests: Formal prerequisite review, Trained clinical neurological examination.

Only if indicated: Protocol-based apnea test with blood gases, Accepted ancillary cerebral perfusion study.

Management pathways in this chapter

Determining Death by Neurologic Criteria

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The pathway step by step, with its decision points
Treatment orders with doses
Why and when to send each test

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