A patient who has been declared brain dead is considered to be both legally and clinically dead. However, we report 2 pediatric cases in which the patients demonstrated clinical signs of brain stem function that are not recognized or tested in current Canadian or US guidelines.
BurkleCMPopeTM. Brain death: legal obligations and the courts. Semin Neurol. 2015;35:174–179.
2.
ShemieSDDoigCDickensB. Brain arrest: the neurological determination of death and organ donor management in Canada. CMAJ. 2006;174(suppl):S1–S30.
3.
NakagawaTAAshwalSMathurM. Clinical report—guidelines for the determination of brain death in infants and children: an update of the 1987 task force recommendations. Pediatrics. 2011;128:e720–e740.
4.
BelkinGS. Death Before Dying. History, Medicine, and Brain Death. New York, NY: Oxford University Press; 2014.
5.
BeecherHK. Ethical problems created by the hopelessly unconscious patient. N Engl J Med. 1968;278:1425–1430.
6.
A definition of irreversible coma. Report of the ad hoc committee of the Harvard Medical School to examine the definition of brain death. JAMA. 1968; 205: 337–340.
7.
SchwabR. EEG as an aid in determining death in the presence of cardiac acuity. Electroencephalogr Clin Neurophysiol. 1963;15:147.
8.
WijdicksEF. Brain death worldwide: accepted fact but no global consensus in diagnostic criteria. Neurology. 2002;58:20–25.
9.
VakilianARIranmaneshFNadimiAEKahnaliJA. Heart rate variability and QT dispersion study in brain death patients and comatose patients with normal brainstem function. J Coll Phys Surg Pakistan. 2011;21:130–133.
10.
ScönmayrR.Cerebral mass displacements. Part II: Clinical findings in primary and secondary brain stem lesions. In: CsésceiGHoffmannOKlugNNorfridKlugLaunAScönmayrRZierskiJ, eds. Primary and Secondary Brain Stem Lesions. Wien: Springer-Verlag; 1987.
11.
BornJD. The Glasgow-Liège Scale. Prognostic value and evolution of motor response and brain stem reflexes after severe head injury. Acta Neurochir (Wien). 1988;91:1–11.
12.
JoffeARAntonNRDuffJP. The apnea test: rationale, confounders and criticism. J Child Neurol. 2010;25:1435–1443.
13.
BernatJL. A defence of the whole brain concept of death. Hastings Center Rep. 1998;28:14–23.
14.
BernatJL. The whole-brain concept of death remains optimum public policy. J Law Med Ethics. 2006;34:35–43.
15.
JoffeAR. Brain death is not death: a critique of the concept, criterion, and tests of brain death. Rev Neurosci. 2009;20:187–198.
16.
JoffeAR. The neurological determination of death: what does it really mean?Issues Law Med. 2007;23:119–140.
17.
Working Group of Conference of Medical Royal Colleges and Faculties in the United Kingdom. The criteria for diagnosis of brain death. J R Coll Physicians. 1995;29:381–382.
18.
JoffeARLequierLCaveD. Specificity of radionuclide brain blood flow testing in brain death: case report and review. J Intensive Care Med. 2010;25:53–64.
19.
KramerAH. Ancillary testing in brain death. Semin Neurol. 2015;35:125–138.
20.
WahlsterSWijdicksEFMPatelPV. Brain death declaration: practices and perceptions worldwide. Neurology. 2015;84:1870–1879.
