JAMA: The latest brain death verdicts are out! The world's expert consensus on brain death.

At present, brain death is the international standard of judgment for death, but the concept, criteria, clinical practice and literature of brain death are not consistent in different countries.
that because of the difficulty of conducting randomized clinical trials and large-scale studies on brain death, there is a lack of strong evidence to develop evidence-based medical recommendations.
in view of this, the World Brain Death Project Team, composed of 45 experts in the field of brain death from around the world, has recently proposed a unified criterion for determining brain death/neurodegenerative death after a comprehensive review of relevant literature and expert opinions.
group recommended that brain death/neurodegeneration be defined as complete and irreversible loss of brain function, i.e. coma without response, loss of consciousness, disappearance of brain-dry reflexes, and inability to breathe autonomously.
this may be due to permanent cessation of the blood supply to the brain or devastating brain damage.
if there is still cellular-level neuron and neuroendocrine activity, or if hormone regulation is still present, it does not interfere with the determination of brain death.
no intervention is required to reduce intracranial pressure when determining whether brain death/neurodegenerative death is irreversible.
in the event of a death, "permanent" means loss of function, inability to recover autonomously, and no recovery in the event of intervention.
group noted that the terms "total brain death" and "brain dry death" should be abandoned and replaced by the "brain death/neurodegenerative death criterion".
in view of the fact that some legal and medical standards in the field of justice use terms such as "whole brain" and "brain dryness", clinicians are advised to use these laws and standards as a guide. The
Expert Group stressed that before assessing whether a patient has a brain death/neurodegenerative death, the patient must already have a diagnosis of the nervous system, which can generally lead to complete and irreversible loss of brain function, while excluding conditions that may confuse clinical examinations and diseases that may resemble brain death/neurodegenerative death.
clinical examination found that the patient was unconscious, brain-dry reflexes disappeared, respiratory stop, can be determined to be brain death / neurodegenerative death, including the following 8 cases.
(1) the strongest external stimuli do not awaken or restore consciousness to the patient, including harmful visual, auditory, tactile stimuli; There was no vomiting reflexes; (6) no cough reflexes under deep-blooded sputum stimulation; (7) there was no brain-controlled motor response in the limbs under harmful stimuli; and (8) there was still no autonomous breathing when the target of pH-lt;7.30 and carbon dioxide fraction pressure (Paco2) was 60 mmHg was achieved.
expert group stressed that if clinical examinations cannot be completed, auxiliary tests, including blood flow studies or electrophysiological tests, should be considered.
the criteria for brain death/neurodegenerative death in children are defined in the same way as for adults, the necessary hemodynamic goals appropriate to their age should be used in the assessment of children.
group noted that religious, social and cultural factors, as well as local legal requirements and resource access, should also be taken into account in assessing brain/neurodegenerative deaths.
group reviewed more than 700 relevant documents published in the three databases of Cochrane, Embase and MEDLINE from 1992 to April 2020.
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