LATE SMT.

INDIRA GANDHI
MEMORIAL GMC KANKER

Brain Death: Concept, Diagnosis

Criteria and Implications
Presented by: Devesh, Devki, Devvrat, Dilip
Date : 25, June
 Introduction
• Brain death is the irreversible loss of all brain
functions.
• • It is a legally accepted definition of death.
• • Explanation: Brain death marks the end of
brain activity despite heartbeat or artificial
support.
 Basic Understanding
• Differs from coma and vegetative states.
• • Brain death implies total brain and
brainstem failure.
• • Explanation: Coma may recover, but brain
death is final with no recovery potential.
 Physiological Basis
• Brain controls consciousness and respiration.
• • Brainstem failure ends all vital reflexes.
• • Explanation: Loss of brainstem function
means no breathing, alertness, or protective
reflexes.
 Legal Definition
• Brain death is considered legal death in India.
• • Allows ethical withdrawal of life support.
• • Explanation: Indian law recognizes brain
death for medical and legal decisions.
 Prerequisites for Testing
• Cause of coma must be known.
• • Exclude reversible causes like drugs or
hypothermia.
• • Explanation: Accurate diagnosis requires
stable, non-reversible conditions.
 Exclusion Criteria
• Rule out hypothermia and drug intoxication.
• • Also exclude shock and electrolyte
imbalances.
• • Explanation: These conditions can mimic
brain death and must be corrected first.
 Clinical Criteria Overview
• Three key signs: unresponsiveness, absent
reflexes, apnea.
• • Must be confirmed by clinical examination.
• • Explanation: These signs help ensure
complete and irreversible brain failure.
 Unresponsiveness
• Patient is in deep coma (GCS 3/15).
• • No purposeful movement or response to
pain.
• • Explanation: Indicates complete loss of
consciousness and awareness.
 Pupillary Reflex
• Pupils are fixed and dilated.
• • No reaction to light observed.
• • Explanation: Loss of midbrain function
controlling pupil response.
 Corneal Reflex
• Touching the cornea causes no blink.
• • Reflex absent in brain death.
• • Explanation: Indicates failure of the pons
and cranial nerve V/VII reflex arc.
 Oculocephalic Reflex
• No eye movement when head turned.
• • 'Doll’s eye' reflex is absent.
• • Explanation: Suggests severe brainstem
dysfunction.
 Vestibulo-Ocular Reflex
• Cold water in ear elicits no eye movement.
• • Indicates brainstem non-function.
• • Explanation: Confirms absence of brainstem-
mediated eye control.
 Gag and Cough Reflex
• Endotracheal stimulation causes no reflex.
• • Absent in confirmed brain death.
• • Explanation: Reflects medullary failure—no
response to airway irritation.
 Apnea Test
• Remove ventilator to test spontaneous
breathing.
• • If no breath with high CO2, confirms brain
death.
• • Explanation: Loss of respiratory center drive
signifies irreversible failure.
 Apnea Test Procedure
• Pre-oxygenate, disconnect ventilator, monitor
CO2.
• • Abort if vital signs deteriorate.
• • Explanation: Safe performance ensures valid
and ethical testing.
 Interpretation of Apnea Test
• Positive: No breath despite PaCO2 rise.
• • Negative: Inconclusive, repeat or reassess.
• • Explanation: Used to confirm medullary loss
of function.
 Confirmatory Tests
• Used when clinical exam is unreliable.
• • Includes EEG, Doppler, and imaging.
• • Explanation: Adds diagnostic confidence in
uncertain or pediatric cases.
 Role of EEG
• Shows flat line (electrocerebral silence).
• • Supports clinical diagnosis of brain death.
• • Explanation: Confirms lack of cortical
electrical activity.
 Cerebral Angiography
• No blood flow to brain indicates death.
• • Doppler or nuclear scans used.
• • Explanation: Brain needs continuous
perfusion—its absence confirms death.
 Legal Panel
• In India, 4 doctors must certify death.
• • Neurologist or intensivist included.
• • Explanation: Legal safeguards ensure
accurate and ethical certification.
 Timing
• Two examinations 6 hours apart (adult).
• • Longer intervals in children.
• • Explanation: Repetition ensures accuracy
and avoids premature decision-making.
 Organ Donation
• Organs retrieved after brain death
confirmation.
• • Donor families must give consent.
• • Explanation: Brain death enables life-saving
transplants from otherwise non-surviving
patients.
 Organ which can donated
After brain death, vital organs like the heart,
lungs, liver, kidneys, pancreas, and intestines
can be donated.
Tissues like corneas, skin, bone, heart valves,
and veins can also be donated.
Donation after brain death is a complex process,
but it allows for the possibility of saving and
improving the lives of others through organ and
tissue transplantation.
 FIRST CASE IN INDIA
1. The first legally recognized case of
brain death in India—and indeed in
South Asia—was certified on
December 25, 1995
2. The patient was a head-trauma
victim, and a committee completed
the clinical diagnosis of brainstem
death
3. subsequently enabling the first
multi-organ transplant in the region
 Conclusion
• Brain death is medically and legally final.
• • Clear criteria ensure ethical diagnosis and
decision-making.
• • Explanation: Proper understanding helps
doctors, families, and society accept and act
upon brain death.
 Summary
1.Introduction
2.Physiological basis
3.Legal definition
4.Prerequisites for testing
5.Clinical criteria
6.Apnea test
7.Organ donation
1. What does brain death imply?
A. Temporary coma
B. Reversible vegetative state
C. Irreversible loss of all brain and brainstem
functions
D. Sleep state due to sedatives
2. Which of the following differentiates brain
death from coma?
A. Eye opening
B. Brainstem reflexes present
C. Possibility of recovery
D. EEG shows activity
3. According to Indian law, brain death is
considered:
A. Suspended animation
B. Reversible coma
C. Legal death
D. Cardiac arrest
4. Before brain death testing, what must be
ensured?
A. Elevated blood pressure
B. Unknown cause of coma
C. All reversible causes are excluded
D. Use of sedatives for calmness
5. Which of the following is NOT an exclusion
criterion for brain death diagnosis?
A. Drug intoxication
B. Hypothermia
C. Intracranial hemorrhage
D. Electrolyte imbalance
6. Which is NOT part of the clinical triad for brain
death?
A. Unresponsiveness
B. Absent brainstem reflexes
C. Hypoglycemia
D. Apnea
What Glasgow Coma Scale (GCS) score is
associated with brain death?
A. 10
B. 7
C. 3
D. 0
8. Fixed and dilated pupils with no light reaction
suggest failure of:
A. Cerebellum
B. Cortex
C. Midbrain
D. Spinal cord
BIBLIOGRAPHY
1. GK. PAL
2. GUYTON AND HALL
3. INTERNET
THANKYOU