Brain Death Determination: TOOLKIT
-
Register
- Non-Physician - Free!
- Student/Resident/Fellow - Free!
- Non-physician Non-member - Free!
- Student/Resident/Fellow Non-member - Free!
- Physician - Free!
- Non-member - Free!
- Physician Non-member - Free!
Already registered?
Log in now.
In this toolkit, you will find many resources to help your understanding of Brain Death/Death by Neurologic Criteria (BD/DNC), both conceptually and in practice. We present here a straightforward, easily accessible set of tools for use by anyone who may be involved in BD/DNC determination.
Table of Contents
- Brain Death Toolkit Foreword
- Pediatric and Adult Brain Death/Death by Neurologic Criteria Consensus Guideline: Report of the AAN Guidelines Subcommittee, AAP, CNS, SCCM
- 2023 AAN Brain Death Guideline eTables
- AAN Brain Death Clinician Tools and Materials
- Sample Brain Death Policy for Hospital Adaptation
- Sample Brain Death Policy Checklist
- Brain Death: Frequently Asked Questions for Healthcare Professionals
- Brain Death: Frequently Asked Questions for the Lay Public
- Brain Death Determination Webinar
- NEJM BD/DNC Exam Video Demonstration on Mannequin
- Determination of Brain Death/Death by Neurologic Criteria: The World Brain Death Project
This content was developed by the NCS Brain Death Task Force as an educational tool and not as a guideline or a policy. The principles of this content are based on the AAN guideline which are generally accepted by the NCS as valid and appropriate. Practitioners should refer to local ordinances that apply to the diagnosis of death in the regions in which they practice.
Copyright 2025 Neurocritical Care Society, Updated 2024
Please click here to view the NCS Legal Disclaimer for the Brain Death Toolkit.
Key:
Complete
Next
Failed
Available
Locked
Brain Death Toolkit: FORWARD
Open to download resource.
Open to download resource.
Brain Death Toolkit Foreword
Brain death, or death by neurologic criteria (BD/DNC) is a medical and legal determination of death. Although revisions to national and international guidelines have taken place over the years, the core principles remain the same, and the concept of BD/DNC has stood the test of time. Guidelines have become more rigorous over time, but variability in policies and practice still exist, and it is important that education surrounding brain death keep pace with guideline updates and best practices.
In this toolkit, you will find many resources to help your understanding of BD/DNC, both conceptually and in practice. We present here a straightforward, easily accessible set of tools for use by anyone who may be involved in BD/DNC determination. It includes a detailed lecture with instructional videos, as well as links to modern resources including new guidelines from the American Academy of Neurology/American Academy of Pediatrics/Society of Critical Care Medicine/Child Neurology Society from 2023, as well as the World Brain Death Project in 2020. A sample BD/DNC policy is provided, as well as a detailed checklist, all updated to reflect the 2023 guidelines. This sample policy can be used as a ready-made template for adoption at individual institutions and hospitals to quickly align with the most up-to-date guidelines. New guidance is provided for such areas as ECMO, hypothermia, primaryposterior fossa injury, CO2 retention, pregnancy, and multiple other circumstances. We also provide Frequently Asked Questions (FAQs) for both healthcare professionals and the general public.
Finally, we provide an online training and credentialing course, serving as a resource for practitioners treating BD/DNC patients worldwide.
We hope you find this toolkit to be a helpful resource, and that it enables you to diagnose and declare BD/DNC 100% of the time, furthering the mission of the Neurocritical Care Society in this domain accurately and appropriately.
David Greer MD, MA, FNCS
Panayiotis Varelas MD, PhD, FNCS
Ariane Lewis MD, FNCS
Matthew Kirschen MD, PhD, FNCS
March 2024
Pediatric and Adult Brain Death/Death by Neurologic Criteria Consensus Guideline: Report of the AAN Guidelines Subcommittee, AAP, CNS, SCCM
Open to download resource.
Open to download resource.
Pediatric and Adult Brain Death/Death by Neurologic Criteria Consensus Guideline: Report of the AAN Guidelines Subcommittee, AAP, CNS, SCCM
David M. Greer, MD, MA, Matthew P. Kirschen, MD, PhD, Ariane Lewis, MD, Gary S. Gronseth, MD, Alexander Rae-Grant, MD, Stephen Ashwal, MD, Maya A. Babu, MD, MBA, David F. Bauer, MD, MPH, Lori Billinghurst, MD MSc, Amanda Corey, MD, Sonia Partap, MD, MS, Michael A. Rubin, MD, MA, Lori Shutter, MD, Courtney Takahashi, MD, Robert C. Tasker, MBBS, MD, Panayiotis Nicolaou Varelas, MD, PhD, Eelco Wijdicks, MD, PhD, Amy Bennett, JD, Scott R. Wessels, MPS, ELS, and John J. Halperin
Background and Objectives
The purpose of this guideline is to update the 2010 American Academy of Neurology (AAN) brain death/death by neurologic criteria (BD/DNC) guideline for adults and the 2011 American Academy of Pediatrics, Child Neurology Society, and Society of Critical Care Medicine guideline for infants and children and to clarify the BD/DNC determination process by integrating guidance for adults and children into a single guideline. Updates in this guideline include guidance related to conducting the BD/DNC evaluation in the context of extracorporeal membrane oxygenation, targeted temperature management, and primary infratentorial injury.
Neurology December 12, 2023 issue 101 (24) 1112-1132
Sample Brain Death Policy for Hospital Adaptation
Open to download resource.
Open to download resource.
The purpose of this policy is to define standards for the determination of death by neurological criteria, also known as “brain death”, in adult patients (defined as those 18 years of age and older for pur poses of this policy) in accordance with institutional, state and federal requirements. This document primarily reflects practice and standards in the United States, and variations exist in other countries.
Sample Brain Death Policy Checklist
Open to download resource.
Open to download resource.
This sample brain death policy checklist includes assessment for confirmed death in adults by neurological criteria in the following areas:
Prerequisites for Clinical Examination
Clinical Exam
Apnea Test
Ancillary Testing
Brain Death: Frequently Asked Questions for Healthcare Professionals
Open to download resource.
Open to download resource.
This document includes answers to questions frequently asked by healthcare professionals regarding BD/DNC. Some of the questions addressed in this document include:
What is the appropriate blood pressure for a BD/DNC evaluation in adults and children?
The terms “Confirmatory” and “Ancillary” testing are both used but can be confusing. Can you explain the difference?
How do you explain BD/DNC to a family who has no understanding of medical terminology or BD/DNC?
Are there any requirements that the clinician ordering the apnea test be present at the bedside during the entire test?
How long does one have to wait after therapeutic hypothermia is utilized and the patient is rewarmed before initiating brain death testing?
What is your experience in patients on ECMO when declaring BD/DNC as technically the flow studies may not show the decreased flow?
...and more!
Brain Death: Frequently Asked Questions for the Lay Public
Open to download resource.
Open to download resource.
Several national surveys indicate there is widespread misunderstanding about brain death, by both the public and the news media. Each year there are approximately 15,000 to 20,000 people declared dead by neurologic criteria and, as our population ages, these numbers may increase. Thus, members of the public are increasingly searching for information about brain death, and they often find conflicting and incorrect information. Well-intentioned but misinformed reporting has resulted in increased confusion. The Neurocritical Care Society, an organization comprised of many the world’s top clinical neuroscience experts, presents this FAQ to shed light upon this topic and dispel the most common misunderstandings. The intended audience is the general public, including families, patients, journalists, and anyone seeking clarification on the subject of brain death.
This FAQ answers questions such as:
Why is brain death so confusing?
What causes brain death?
How is brain death diagnosed?
What happens to a person once brain death is diagnosed?
Don’t you need a brain scan or a brain wave test for brain death?
...and many more!
Brain Death Determination Webinar
Open to view video.
Open to view video.
Recreation or use of this video outside of the NCS toolkit is prohibited.
