Brain Death

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Brain Death provides a practical, comprehensive, clinical resource for practitioners seeing patients with acute catastrophic neurologic disorders evolving to brain death and all its ramifications. The clinical diagnosis of brain death has tremendous implications: its main purpose is to bring closure, but it often results in organ and tissue transplantation questions which need to be addressed.

This third edition introduces new research in the intensive care unit, newly unearthed historical data on important US-UK differences, a thorough discussion of US guidelines and how it is used in hospital practices, and compares guidelines used elsewhere in the world. In this incisive work, the many complexities of diagnosis and management of brain death are examined but it also illuminates cultural beliefs and bioethical problems, highlights the nature of conferences with family members, and captures several organ procurement issues. The book also includes 30 commonly asked practice problems to resolve diagnostic uncertainties and conflicts along with 10 video clips to assist in neurological evaluation.

Brain Death is a treatise by the leading expert on brain death, Eelco F.M. Wijdicks. This book is a work of primary source research and includes work from recent publications by the author. It is an invaluable resource for neurologists, neurointensivists, neurosurgeons, anesthesiologists, trauma surgeons, neuroscience and intensive care nursing staff, transplantation surgeons, and organ procurement organizations.

Table of Contents

Preface to the Third Edition
Preface to the Second Edition
Acknowledgments
Chapter 1: History of Brain Death
A New Comatose State Appears
Defining Neurologic Criteria for Death in Us
Chapter 2: Neurology of Brain Death
The Pathology of Brain Death
Clinical Examination in Adults
The Clinical Determination of Brain Death in Children
Documentation
Teaching Brain Death Determination
Errors and Alleged Recoveries
Legal Definitions and Obligations
Chapter 3: International Criteria of Brain Death
Guidelines in the United Kingdom
Guidelines World Wide
Consensus for a Uniform World Wide Standard
Chapter 4: Beliefs About Brain Death
Religious Beliefs
Cultural Views
Religious Conflict Resolution
Chapter 5: Critics and Brain Death
The Uncertainty of Death
Emerging Controversies
Critique
Chapter 6: Procurement After Brain Death
Transitioning to Organ Donation
Organ Procurement Organizations
Organ Donation Requests
Preparation for Determining Organ Suitability
Donation Protocols
Medical Management of the Organ Donor
Chapter 7: Clinical Problems in Brain Death and Organ Donation
1. The Qualifications of the Examiner
2. Clinical Mimics
3. Acid-Base Disturbances
4. Electrolyte Abnormalities
5. Acute Intoxications and Overdose
6. Reliability of Ancillary Tests
7. Ancillary Tests and Confounders
8. Primary Brainstem Lesion
9. Uncertainty About Interpreting Spinal Reflexes
10. Ventilator Autocycling
11. Chronic CO2 Retention and Apnea Test
12. Terminating the Apnea Test
13. Breathing during the Apnea Test
14. Pneumothorax during the Apnea Test
15. Cardiopulmonary Resuscitation
16. Extracorporeal Membrane Oxygenation
17. Anencephaly
18. Shaken Baby Syndrome
19. Maternal Brain Death
20. Legal Challenges
21. Family Opposition
22. Family Presence during Testing
23. Sperm and Oocyte Retrieval
24. Organ Donation Management
25. Organ Donation and the Hemodynamically Unstable Donor
26. DCD Pitfalls
27. DCD in the Operating Room
28. Organ Donation in Prisoners
29. Organ Donation, Consent and Costs
30. Organ Donation and Directing the Gift
Index

Eelco F.M. Wijdicks, MD, Prof, Mayo Clinic

Eelco F.M. Wijdicks is Professor of Neurology, Mayo Clinic College of Medicine, Chair of the Division of Critical Care Neurology, and Consultant, Neurological Neurosurgical Intensive Care Unit, Saint Marys Hospital, Mayo Clinic