The most recent 2023 evidence-based guideline on the determination of death by neurologic criteria is entitled, “Pediatric and Adult Brain Death/Death by Neurologic Criteria.” The consensus guideline was established by the American Academy of Neurology (AAN), American Academy of Pediatrics (AAP), Child Neurology Society (CNS), and the Society of Critical Care Medicine (SCCM). It is the accepted medical standard for determining brain death in pediatric and adult patients.

These groups are the only national or international medical societies that have taken responsibility for writing guidelines on the determination of death by neurologic criteria in the United States since the 1980s. ISMA currently has existing, but now outdated policies on brain death under Resolutions 22-82 (originally 12-02) and 17-04. These resolutions have been repealed and replaced with Resolution 25-64 (Synchronizing ISMA policy on Brain Death with Current Evidence-Based Guidelines), which adopts the 2023 guideline. 
 
“Brain death means that clinicians cannot observe or elicit any clinical signs of brain function,” said author David M. Greer, MD, FAAN, FCCM, of Boston University in Massachusetts. “Brain death is different from comatose and vegetative states. People do not recover from brain death. Brain death is legal death.” 

The consensus practice guideline outlines the standardized procedure for trained clinicians to evaluate people for brain death. As part of this procedure, clinicians perform an evaluation to determine whether there is any clinical functioning of the brain and brainstem, including whether the person breathes on their own. Brain death is declared if a person has a catastrophic brain injury, has no possibility of recovering any brain function, is completely unresponsive, does not demonstrate any brain or brainstem function, and does not breathe on their own. This guideline includes updates on the prerequisites for brain death determination, the examination and the examiners, apnea testing and ancillary testing. 

As part of the guideline, a digital application has been developed to walk clinicians through the process of brain death determination. It is available for free on AAN.com. A checklist of recommendations is provided in the published paper. An illustration is also provided, which follows a flowchart for brain death determination.