Guidelines of the 1987 Pediatric Special Task Force for Brain Death in Children

 

Criteria in history:

(1) The etiologic cause must be irreversible.

(2) Exclusion of reversible toxic or metabolic disease, sedative-hypnotic drugs, paralytic agents, hypothermia, hypotension or surgically correctable conditions.

 

Criteria on physical examination:

(1) both coma and apnea (complete loss of consciousness, vocalization and volitional activity)

(2) absence of brain stem function

(3) not significantly hypothermic or hypotensive for age

(4) flaccid tone

(5) absence of spontaneous or induced movements (excluding reflex withdrawal or spinal myoclonus)

(6) findings fully consistent with brain death during the observation and testing period (nothing inconsistent)

 

Absence of brain function:

(1) midposition or fully dilated pupils that do not respond to light AND the patient is not receiving drugs that cause these findings

(2) absence of spontaneous eye movements induced by oculocephalic and oculovestibular (caloric) testing

(3) absence of movements of bulbar musculature including facial and oropharyngeal muscles.

(4) absence of corneal, gag, cough, sucking and rooting reflexes

(5) respiratory movements are absent if the patient is off the respirator

 

Age of Patient	Observation Period
newborn	observe until 7 days after insult, then 2 examinations and EEGs separated by at least 48 hours
7 days to 2 months	2 examinations and EEGs separated by at least 48 hours
2 months to 1 year	(2 examinations and EEGs separated by at least 24 hours) OR (1 examination and EEG and angiographic evidence of absent cerebral circulation)
> 1 year, hypoxic-ischemic encephalopathy	(observation period of at least 24 hours) OR (shorter observation period and EEG silent) OR (shorter observation period and angiographic evidence of absent cerebral circulation)
> 1 year, other	observation period of at least 12 hours

 

Confirmatory testing:

(1) EEG silence not explained by drugs or other cause

(2) angiographic evidence of absent cerebral circulation

 

EEG testing:

(1) performed over 30 minutes

(2) interelectrode distance appropriate for the patient's head size

(3) sedative-hypnotic drug levels insufficient to suppress EEG activity