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Palliative Care1931 papers

Brainstem death

Last edited: 4/23/2026

Overview

Brainstem death refers to the irreversible cessation of all brain functions, including those of the brainstem, indicating the biological death of an individual despite the presence of circulatory and respiratory support. It is a critical criterion for determining death in clinical settings, particularly for organ donation 89.

Diagnosis

  • Key Criteria: Irreversible loss of brain stem function, confirmed by absence of brainstem reflexes and apnea test 8.
  • Recommended Tests: Clinical examination including pupillary response, corneal reflex, motor response, and apnea test 8.
  • Supplemental Testing: Brain imaging (e.g., MRI, CT) and electroencephalography (EEG) may support diagnosis but are not definitive 8.
  • Grading: No standardized grading system; diagnosis relies on consistent clinical criteria 8.

    • Management

  • Communication: Transparent and compassionate communication with families regarding diagnosis and organ donation options 16.
  • Palliative Care: Integration of palliative care to support both patients and families 16.
  • Organ Donation: Facilitating organ donation when appropriate, ensuring adherence to ethical and legal standards 11.

    • Special Populations

  • Pediatrics: Pediatric criteria closely follow adult guidelines but require specialized pediatric expertise 8.
  • Pregnancy: Specific guidelines for fetal death emphasize cessation of cardiac activity post-14 weeks gestational age 1.
  • Elderly: No unique diagnostic criteria; brainstem death criteria apply universally but may require careful assessment of comorbidities 8.

    • Key Recommendations

  • Diagnosis Requires Comprehensive Neurological Examination: Confirm irreversible loss of brain stem function through clinical criteria including brainstem reflexes and apnea test (Evidence: Strong 8).
  • Family Involvement and Communication: Engage families in discussions about brainstem death and organ donation options with sensitivity and clarity (Evidence: Moderate 16).
  • Palliative Care Integration: Incorporate palliative care services to support patients and families through the process (Evidence: Expert opinion 16).
  • Adherence to Ethical Guidelines: Ensure all procedures align with ethical standards and legal requirements for organ donation (Evidence: Expert opinion 11).

    • References

    Showing 100 most recent of 228 indexed papers.

    1 Garabedian C, Sibiude J, Anselem O, Attie-Bittach T, Bertholdt C, Blanc J et al.. Fetal death: Expert consensus of the French College of Obstetricians and Gynecologists. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2025. link 2 Koh S, Park S, Lee M, Kim H, Lee WJ, Lee JM et al.. Assessing the Brain Death/Death by Neurologic Criteria Determination Process in Korea: Insights from 10-Year Noncompleted Donation Data. Neurocritical care 2025. link 3 Cohen PR, Abdulkarim B, Wnuk M, Sutton L, Hoenig LJ. Identification of decedents by restoring mummified fingerprints: Forensic dermatology in the investigation of mummy dermatoglyphics. Clinics in dermatology 2024. link 4 Rockoff MA, Van Cleve W, Van Norman GA. Anesthesiologists and Capital Punishment. Anesthesiology clinics 2024. link 5 Renckens SC, Pasman HR, Veldhuijzen NJ, Onwuteaka-Philipsen BD. The provision of bereavement care by general practitioners: data from a sentinel network. BMC primary care 2024. link 6 Suntai Z, Laha-Walsh K, Albright DL. Perspectives on a good death: A comparative study of veterans and civilians. Death studies 2024. link 7 Dean D, Garber MD, Anderson GB, Rojas-Rueda D. Health implications of urban tree canopy policy scenarios in Denver and Phoenix: A quantitative health impact assessment. Environmental research 2024. link 8 Greer DM, Kirschen MP, Lewis A, Gronseth GS, Rae-Grant A, Ashwal S et al.. Pediatric and Adult Brain Death/Death by Neurologic Criteria Consensus Guideline. Neurology 2023. link 9 Shemie SD, Wilson LC, Hornby L, Basmaji J, Baker AJ, Bensimon CM et al.. A brain-based definition of death and criteria for its determination after arrest of circulation or neurologic function in Canada: a 2023 clinical practice guideline. Canadian journal of anaesthesia = Journal canadien d'anesthesie 2023. link 10 Lewis A, Kirschen MP, Badenes R. Quality improvement in the determination of death by neurologic criteria around the world. Critical care (London, England) 2023. link 11 Nickerson TE, Lovett ME, O'Brien NF. Organ Dysfunction Among Children Meeting Brain Death Criteria: Implications for Organ Donation. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies 2023. link 12 Braund S, Leviel J, Morau E, Deneux-Tharaux C, Verspyck E. Maternal sudden death: A nationwide retrospective study. BJOG : an international journal of obstetrics and gynaecology 2023. link 13 Ding Q, Loganathan S, Zhou P, Sayour AA, Brlecic P, Radovits T et al.. Alpha-1-Antitrypsin Protects Vascular Grafts of Brain-Dead Rats Against Ischemia/Reperfusion Injury. The Journal of surgical research 2023. link 14 Hoyert DL, Gregory EC. Cause-of-death Data From the Fetal Death File,2018-2020. National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System 2022. link 15 Weaver R, Bolkan C, Decker A. High death anxiety and ambiguous loss: Lessons learned from teaching through the COVID-19 pandemic. Gerontology & geriatrics education 2022. link 16 Kramer NM, O'Mahony S, Deamant C. Brain Death Determination and Communication: An Innovative Approach Using Simulation and Standardized Patients. Journal of pain and symptom management 2022. link 17 Stolz E, Gill TM, Mayerl H, Rásky É, Freidl W. Trajectories of Late-Life Disability Vary by the Condition Leading to Death. The journals of gerontology. Series A, Biological sciences and medical sciences 2021. link 18 Lou Y, Liu J. Death Narrative in 19th-Century China: How Did Newspapers Frame Death and Dying. Omega 2021. link 19 Thornton R, Nicholson P, Harms L. Being a Parent: Findings from a Grounded Theory of Memory-Making in Neonatal End-of-Life Care. Journal of pediatric nursing 2021. link 20 Abdel Razeq NM, Al-Gamal E. Informing mothers of neonatal death and the need for family-centered bereavement care: A phenomenological qualitative study. Journal for specialists in pediatric nursing : JSPN 2021. link 21 Ahmed R, Weaver L, Falvo L, Bona A, Poore J, Schroedle K et al.. Rapid-cycle deliberate practice: death notification. The clinical teacher 2020. link 22 Lim JY, Jung KY, Lee DH, Yang KM, Choi M, Park JP et al.. A prospective study about the discrepancy between postmortem inspections conducted by emergency physicians and forensic pathologists. Journal of forensic and legal medicine 2020. link 23 Lim JY, Yang KM, Lee DH. Study on death certificates and postmortem examination certificates written by Korean emergency physicians. Journal of forensic and legal medicine 2020. link 24 Edwards F. National Children's Hospitals Bereavement Network standards for supporting families following the death of a child. Nursing children and young people 2020. link 25 Weedn VW, Menendez MJ. Reclaiming the Autopsy as the Practice of Medicine: A Pathway to Remediation of the Forensic Pathology Workforce Shortage?. The American journal of forensic medicine and pathology 2020. link 26 Armendariz Dyer MJ. "Thou Shalt Not Die in This Place": An Ethnomethodological Approach to an Ecuadorian Hospice Through Symbolic Interactionism. Omega 2020. link 27 Kalseth J, Halvorsen T. Relationship of place of death with care capacity and accessibility: a multilevel population study of system effects on place of death in Norway. BMC health services research 2020. link 28 Fleming P, Pease A, Ingram J, Sidebotham P, Cohen MC, Coombs RC et al.. Quality of investigations into unexpected deaths of infants and young children in England after implementation of national child death review procedures in 2008: a retrospective assessment. Archives of disease in childhood 2020. link 29 Moya Sánchez J, Royo-Villanova Reparaz M, Andreu Ruiz A, Ros Argente Del Castillo T, Sánchez Cámara S, de Gea García JH et al.. Portable gamma-camera for the diagnosis of brain death diagnosis. Medicina intensiva 2020. link 30 Akkas M, Demir MC. Barriers to Brain Death Notifications From Emergency Departments. Transplantation proceedings 2019. link 31 Donati S, Maraschini A, Dell'Oro S, Lega I, D'Aloja P. The way to move beyond the numbers: the lesson learnt from the Italian Obstetric Surveillance System. Annali dell'Istituto superiore di sanita 2019. link 32 Martins MCF, Feitosa FEL, Viana Júnior AB, Correia LL, Ibiapina FLP, Pacagnella RC et al.. Pregnancies with an outcome of fetal death present higher risk of delays in obstetric care: A case-control study. PloS one 2019. link 33 Mutlu V, Utku T. Knowledge and Attitude Toward Brain Death and Organ Donation Among Anesthesiology and Reanimation Professionals. Transplantation proceedings 2019. link 34 Fujita A, Hamada Y. Bereavement care in Japanese pediatrics: Pediatrician awareness in practice. Pediatrics international : official journal of the Japan Pediatric Society 2019. link 35 Magalhães DMS, Zanoni FL, Correia CJ, Simas R, Soares RGF, Sannomiya P et al.. Hypertonic Saline Modulates Heart Function and Myocardial Inflammatory Alterations in Brain-Dead Rats. The Journal of surgical research 2019. link 36 Miller FG. Medical Futility and "Brain Death". Perspectives in biology and medicine 2018. link 37 Lavelle M, Abthorpe J, Simpson T, Reedy G, Little F, Banerjee A. MBRRACE in simulation: an evaluation of a multi-disciplinary simulation training for medical emergencies in obstetrics (MEmO). Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology 2018. link 38 Lewis C, Hill M, Arthurs OJ, Hutchinson JC, Chitty LS, Sebire N. Health professionals' and coroners' views on less invasive perinatal and paediatric autopsy: a qualitative study. Archives of disease in childhood 2018. link 39 Vodovnik A, Aghdam MRF, Espedal DG. Remote autopsy services: A feasibility study on nine cases. Journal of telemedicine and telecare 2018. link 40 Bakhbakhi D, Siassakos D, Storey C, Heazell A, Lynch M, Timlin L et al.. PARENTS 2 study protocol: pilot of Parents' Active Role and ENgagement in the review of Their Stillbirth/perinatal death. BMJ open 2018. link 41 Soltesz K, Sjöberg T, Jansson T, Johansson R, Robertsson A, Paskevicius A et al.. Closed-loop regulation of arterial pressure after acute brain death. Journal of clinical monitoring and computing 2018. link 42 Belhomme N, Le Noir De Carlan M, Lescoat A, Le Gallou T, Rouget F, Loget P et al.. Investigating in utero fetal death: outcome of internal medicine consultation. International journal of rheumatic diseases 2018. link 43 Sefansky S. Involved in the Business of Death: The Social Work Role in Postmortem Care. Health & social work 2017. link 44 Bakhbakhi D, Siassakos D, Burden C, Jones F, Yoward F, Redshaw M et al.. Learning from deaths: Parents' Active Role and ENgagement in The review of their Stillbirth/perinatal death (the PARENTS 1 study). BMC pregnancy and childbirth 2017. link 45 Timucin AC, Basaga H. Pro-apoptotic effects of lipid oxidation products: HNE at the crossroads of NF-κB pathway and anti-apoptotic Bcl-2. Free radical biology & medicine 2017. link 46 Costa AF, Hoek G, Brunekreef B, Ponce de Leon AC. Air Pollution and Deaths among Elderly Residents of São Paulo, Brazil: An Analysis of Mortality Displacement. Environmental health perspectives 2017. link 47 Soltesz K, Sturk C, Paskevicius A, Liao Q, Qin G, Sjoberg T et al.. Closed-Loop Prevention of Hypotension in the Heartbeating Brain-Dead Porcine Model. IEEE transactions on bio-medical engineering 2017. link 48 Vojtíšek T, Kučerová Š, Krajsa J, Eren B, Vysočanová P, Hejna P. Postmortem Increase in Body Core Temperature: How Inaccurate We Can Be in Time Since Death Calculations. The American journal of forensic medicine and pathology 2017. link 49 Tingle J. Learning from mistakes in the NHS: a special PHSO report. British journal of nursing (Mark Allen Publishing) 2016. link 50 . Butterfly logo may prevent needless upset for mothers. Nursing children and young people 2016. link 51 O'Meara M, Trethewie S. Managing paediatric death in the emergency department. Journal of paediatrics and child health 2016. link 52 Heard GC, Thomas RD, Sanderson PM. In the Aftermath: Attitudes of Anesthesiologists to Supportive Strategies After an Unexpected Intraoperative Patient Death. Anesthesia and analgesia 2016. link 53 Guidry-Grimes L. The Case of Ms D: A Family's Request for Posthumous Procurement of Ovaries. The Journal of clinical ethics 2016. link 54 Kusakabe A, Naito AS, Hirano K, Ikenaga K, Saitou N, Mikan H et al.. Death Pronouncements: Recommendations Based on a Survey of Bereaved Family Members. Journal of palliative medicine 2016. link 55 Hellmann J, Knighton R, Lee SK, Shah PS. Neonatal deaths: prospective exploration of the causes and process of end-of-life decisions. Archives of disease in childhood. Fetal and neonatal edition 2016. link 56 Brady M. Death anxiety among emergency care workers. Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association 2015. link 57 Hammer U, Boy D, Rothaupt D, Büttner A. Distinction between forensic evidence and dermatological findings. Journal of forensic and legal medicine 2015. link 58 Juszka K, Juszka K. A researcher's review of adherence to forensic examination principles in homicide cases in Poland. Archiwum medycyny sadowej i kryminologii 2015. link 59 Cain MD, Siebert JR, Iriabho E, Gruneberg A, Almeida JS, Faye-Petersen OM. Development of novel software to generate anthropometric norms at perinatal autopsy. Pediatric and developmental pathology : the official journal of the Society for Pediatric Pathology and the Paediatric Pathology Society 2015. link 60 Quinlan M, Fitzpatrick SJ, Matthews LR, Ngo M, Bohle P. Administering the cost of death: organisational perspectives on workers' compensation and common law claims following traumatic death at work in Australia. International journal of law and psychiatry 2015. link 61 O'Malley PJ, Barata IA, Snow SK. Death of a child in the emergency department. Journal of emergency nursing 2014. link 62 O'Malley PJ, Barata IA, Snow SK. Death of a child in the emergency department. Annals of emergency medicine 2014. link 63 Manskikh VN. The problem of determination of cause of laboratory animal's death: a critical review of definitions of "fatal" and "incidental" lesions. Biochemistry. Biokhimiia 2014. link 64 Duffey H. Water immersion in neonatal bereavement photography. Nursing for women's health 2014. link 65 Schep LJ, Slaughter RJ, Vale JA, Wheatley P. Was the death of Alexander the Great due to poisoning? Was it Veratrum album?. Clinical toxicology (Philadelphia, Pa.) 2014. link 66 Fukushima N, Ono M, Saito S, Saiki Y, Kubota S, Tanoue Y et al.. Heart donation in Japan before and after the revision of the Japanese Transplantation Act. Transplantation proceedings 2014. link 67 Billingsley L, Currie PS. Using social media to share the death experience: discussion points. Journal of continuing education in nursing 2013. link 68 Hobgood C, Mathew D, Woodyard DJ, Shofer FS, Brice JH. Death in the field: teaching paramedics to deliver effective death notifications using the educational intervention "GRIEV_ING". Prehospital emergency care 2013. link 69 Pearce L. A place to say goodbye. Nursing standard (Royal College of Nursing (Great Britain) : 1987) 2013. link 70 Mikhova KM, Don CW, Laflamme M, Kellum JA, Mulligan MS, Verrier ED et al.. Effect of cytokine hemoadsorption on brain death-induced ventricular dysfunction in a porcine model. The Journal of thoracic and cardiovascular surgery 2013. link 71 Kubat B, Duijst W, van de Langkruis R, Thoonen E. Dying in the arms of Dutch governmental authorities. Journal of forensic and legal medicine 2013. link 72 Oh SY, Kim JS, Lee JM, Shin BS, Hwang SB, Kwak KC et al.. Ocular vestibular evoked myogenic potentials induced by air-conducted sound in patients with acute brainstem lesions. Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology 2013. link 73 Rushing DS. "Am I going to die, aunt Deborah?". Journal of Christian nursing : a quarterly publication of Nurses Christian Fellowship 2012. link 74 Gilmore T. Reflections on giving bad news. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 2012. link 75 Marck CH, Weiland TJ, Neate SL, Hickey BB, Jelinek GA. Australian emergency doctors' and nurses' acceptance and knowledge regarding brain death: a national survey. Clinical transplantation 2012. link 76 Fernando D, Oxley JD, Nottingham J. Death certification: do consultant pathologists do it better?. Journal of clinical pathology 2012. link 77 Romanelli MC, Gelardi M, Fiorella ML, Tattoli L, Di Vella G, Solarino B. Nasal ciliary motility: a new tool in estimating the time of death. International journal of legal medicine 2012. link 78 Scarre G. Can there be a good death?. Journal of evaluation in clinical practice 2012. link 79 Holm MS, Fålun N, Gjengedal E, Norekvål TM. Music during after-death care: a focus group study. Nursing in critical care 2012. link 80 Roberts IS, Benamore RE, Benbow EW, Lee SH, Harris JN, Jackson A et al.. Post-mortem imaging as an alternative to autopsy in the diagnosis of adult deaths: a validation study. Lancet (London, England) 2012. link61483-9) 81 Thiele P. Going against the grain: Liam's story. Journal of paediatrics and child health 2011. link 82 Strote J, Schroeder E, Lemos J, Paganelli R, Solberg J, Range Hutson H. Academic emergency physicians' experiences with patient death. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 2011. link 83 Reid M, McDowell J, Hoskins R. Breaking news of death to relatives. Nursing times 2011. link 84 Janvier A, Meadow W, Leuthner SR, Andrews B, Lagatta J, Bos A et al.. Whom are we comforting? An analysis of comfort medications delivered to dying neonates. The Journal of pediatrics 2011. link 85 Lovrencic-Huzjan A, Vukovic V, Gopcevic A, Vucic M, Kriksic V, Demarin V. Transcranial Doppler in brain death confirmation in clinical practice. Ultraschall in der Medizin (Stuttgart, Germany : 1980) 2011. link 86 Forrest KM, Siddiqui A, Lim M, Wraige E. Basilar artery dolichoectasia in childhood: evidence of vascular compromise. Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery 2011. link 87 Peschel O, Kunz SN, Rothschild MA, Mützel E. Blood stain pattern analysis. Forensic science, medicine, and pathology 2011. link 88 Sieswerda-Hoogendoorn T, van Rijn RR. Current techniques in postmortem imaging with specific attention to paediatric applications. Pediatric radiology 2010. link 89 Gold KJ, Leon I, Chames MC. National survey of obstetrician attitudes about timing the subsequent pregnancy after perinatal death. American journal of obstetrics and gynecology 2010. link 90 Todesco J, Rasic NF, Capstick J. The effect of unanticipated perioperative death on anesthesiologists. Canadian journal of anaesthesia = Journal canadien d'anesthesie 2010. link 91 Lundgren BS, Houseman CA. Banishing death: the disappearance of the appreciation of mortality. Omega 2010. link 92 Maeda H, Zhu BL, Ishikawa T, Michiue T. Forensic molecular pathology of violent deaths. Forensic science international 2010. link 93 Ardhanari S, Gomathi S B, Anita L, Harish A, Ajit S M, Pandurangi UM. Brainstem infarct presenting as torsades de pointes. Indian heart journal 2009. link 94 Callahan D. Death, mourning, and medical progress. Perspectives in biology and medicine 2009. link 95 Zeyrek EY, Lester D. Cronbach alpha reliability and concurrent validity of the Collett-Lester Fear of Death Scale in a Turkish sample. Psychological reports 2008. link 96 Gettman MT, Karnes RJ, Arnold JJ, Klipfel JM, Vierstraete HT, Johnson ME et al.. Urology resident training with an unexpected patient death scenario: experiential learning with high fidelity simulation. The Journal of urology 2008. link 97 Gold KJ, Kuznia AL, Hayward RA. How physicians cope with stillbirth or neonatal death: a national survey of obstetricians. Obstetrics and gynecology 2008. link 98 Biggs MJ, Brown LJ, Rutty GN. Can cause of death be predicted from the pre-necropsy information provided in coroners' cases?. Journal of clinical pathology 2008. link 99 Krous HF, Langston C. The role of the pediatric pathologist as expert witness in a case of neonatal death. Pediatric and developmental pathology : the official journal of the Society for Pediatric Pathology and the Paediatric Pathology Society 2008. link 100 Gonzalez F, Hereira M. Home-based viewing (el velorio) after death: a cost-effective alternative for some families. The American journal of hospice & palliative care 2008. link

    Original source

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