الفهرس 
Diagnosis of brain deathOnly 14 pages are availabe for public view
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Abstract
Till the 1950s it was breathing and heartbeat which were taken
to signify the continued life of a human being, and it was the
permanent cessation of these activities which were taken to constitute
human death. However various medical advances throughout the
1950s and 1960s altered the perceived significance of these signs.
Recovery from cardiac arrest became more common; mechanical
ventilation assisted those not able to breathe spontaneously. Then on
December 3rd 1967, the first successful heart transplant was carried
out on a human being. The heart seemed not to be irreplaceable after
all. Further, if machines could substitute for the function of the heart
or the lungs then these organs could not themselves constitute human
life. Only the brain seemed irreplaceable in this way; so criteria for
death shifted from referring to heart and lungs to referring to the
brain.
By the end of the 19th century it was known that, during an
increase in intracranial pressure, respirations suddenly stopped
whereas the heart continued to beat for some time. The widespread
use of mechanical ventilators that prevent respiratory arrest has
transformed the course of terminal neurologic disorders. Vital
functions can now be maintained artificially after the brain has ceased
to function. This lead to development of the criteria of brain death the
primary concern was to provide an acceptable mechanism to permit
withdrawal of mechanical ventilatory support from such patients, and
that removal of organs for transplantation was secondary.
It is important to stress on the difference between severe brain
damage and brain death. The physician must understand this
difference, because brain death means that life support is useless, and
brain death is the principal requisite for the donation of organs for
transplantation.
The clinical neurologic examination remains the standard for
the determination of brain death and has been adopted by most
countries. The clinical examination of patients who are presumed to
be brain dead must be performed with precision. The declaration of
brain death requires not only a series of careful neurologic tests but
also the establishment of the cause of coma, the ascertainment of
irreversibility, the resolution of any misleading clinical neurologic
Summary
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signs, the recognition of possible confounding factors, the
interpretation of the findings on neuroimaging, and the performance
of any confirmatory laboratory tests that are deemed necessary.