Brain death: the doctor explains

In this video, Prof. HPH Kremer, neurologist at UMC Groningen, explains how the brain functioning, what the function of the brain is and which aspects are connected to the concept brain dead. The determination of brain death is done very carefully according to the Brain Death Protocol.

This protocol has a legal basis and must be used by all hospitals. The protocol describes step-by-step which examinations doctors must perform to determine brain death. These doctors are not involved in the removal and transplantation of organs.

The attending physician(s) will determine brain death if research shows that:

• The brain damage is fatal and untreatable. Causes of unconsciousness and reactionlessness such as hypothermia and poisoning must be excluded.
• Both consciousness and brainstem reflexes are missing.
• There is no electrical activity and no spontaneous breathing.

To test
An Electroencephalogram (EEG) measures the electrical activity of the brain. If no electrical activity is measured, confusion with coma is immediately ruled out. In coma, also called suspended animation, there is still electrical activity in the brain. The test is performed at least twice. In the apnea test, the ventilator is disconnected to see if breathing comes spontaneously. This uses carbon dioxide measurements in the blood.

Contrast fluid
If an EEG is not possible (for example with a crushed skull) or if it appears that the apnea test cannot be performed properly, an angiogram is performed. This is an examination of the blood vessels, in which the doctor injects contrast medium into the brain and thus can determine whether there is still blood flowing through the brain.

Time of death
The moment at which brain death is diagnosed is the official time of death. This definitive diagnosis can therefore only be made after all prescribed examinations have been performed.