When Determining Brain Death in Adults, Time Is of the Essence!: The Last Nail in the Coffin of Dual Examination in Brain Death

Neurologic catastrophes may lead to brain death (BD), an unfortunate endpoint affecting approximately 1 victim in America every 30 minutes.1 BD is better designated as death by neurologic criteria (DNC)2,3 and relies on a precise process of determining the etiologic context of this neurologic catastrophe, establishing the brain injury, affirming irreversibility of the pathologic process, excluding medical confounders, confirming adequate perfusion and safety requisites for a complete examination before ascertaining clinically the lack of cortical and brainstem functions as a whole, and finally resorting to ancillary testing only when the clinical examination is uncertain or incomplete.2,3 This BD determination process must be accurate, but DNC also needs to be determined as early as practical to open the door of a possible brighter prospect in these most tragic scenarios through organ donation.4,5

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