Brain Death (Brain Dead)

A state of prolonged irreversible cessation of all brain activity, including lower brain stem function with the complete absence of voluntary movements, responses to stimuli, brain stem reflexes, and spontaneous respirations. Reversible conditions which mimic this clinical state (e.g., sedative overdose, hypothermia, etc.) are excluded prior to making the determination of brain death. (From Adams et al., Principles of Neurology, 6th ed, pp348-9)

Also Known As:

Networked: 2313 relevant articles (76 outcomes, 226 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Apnea
2.	Death (Near-Death Experience)
3.	Ischemia
4.	Inflammation
5.	Shock

Experts

1.	Ploeg, Rutger J: 27 articles (06/2015 - 10/2003)
2.	Leuvenink, Henri G D: 17 articles (06/2015 - 11/2003)
3.	Pratschke, J: 14 articles (11/2015 - 02/2000)
4.	Wijdicks, Eelco F M: 12 articles (05/2015 - 09/2005)
5.	Schnuelle, Peter: 11 articles (05/2015 - 05/2004)
6.	Yard, Benito A: 11 articles (05/2015 - 05/2004)
7.	Hoeger, Simone: 11 articles (05/2015 - 09/2007)
8.	Ploeg, R J: 11 articles (03/2012 - 12/2000)
9.	Tilney, N L: 10 articles (09/2002 - 01/2000)
10.	Seelen, Marc A: 9 articles (06/2015 - 04/2008)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Brain Death:

1.	Norepinephrine (Noradrenaline)FDA LinkGeneric 06/01/2008 - "Twenty brain-dead donors were treated with norepinephrine within the study period. " 02/01/1994 - "The present study confirms the onset of a dramatic increase in cardiac norepinephrine release from myocardial nerve endings following brain death, and demonstrate the utility of the new cardiac microdialysis technique to assess changes in interstitial fluid content." 02/01/1994 - "This study was designed to evaluate the utility of cardiac microdialysis to measure interstitial myocardial norepinephrine release resulting from brain death. " 01/01/2014 - "Although there were more patients in the steroid group who received norepinephrine before brain death (80% vs. 66%: P = 0.03), mean dose of vasopressor administered after brain death was significantly lower than in the control group (1.18 ± 0.92 mg/H vs. 1.49 ± 1.29 mg/H: P = 0.03), duration of vasopressor support use was shorter (874 min vs. 1160 min: P < 0.0001) and norepinephrine weaning before aortic clamping was more frequent (33.8% vs. 9.5%: P < 0.0001). " 12/01/2010 - "Norepinephrine was reduced to 0.2-0.5 mg/h within 2 h before brain death was diagnosed according to the criteria of the German Medical Association. "
2.	Acetylcysteine (Siran)FDA LinkGeneric 01/01/2010 - "Protective effects of N-acetylcysteine on the liver of brain-dead Ba-Ma mini pig." 09/01/2009 - "Mechanism of the protective effects of N-acetylcysteine on the heart of brain-dead Ba-Ma miniature pigs." 08/01/2006 - "Protective effects of N-acetylcysteine on brain-dead rat liver." 09/01/2009 - "This study examined the expression of NF-kappaB in the hearts of brain-dead Ba-Ma miniature pigs and the protection potential of N-acetylcysteine. " 09/01/2009 - "N-acetylcysteine can alleviate both structural and functional injury of the heart during brain death, which might be related to the inhibition of NF-kappaB expression and decreasing release of inflammatory mediators."
3.	Dopamine (Intropin)FDA LinkGeneric 05/15/2004 - "In two independent retrospective clinical studies, we showed that dopamine treatment of brain-dead donors improves long-term kidney graft survival. " 12/01/1999 - "Bio-energetic response of the heart to dopamine following brain death-related reduced myocardial workload: a phosphorus-31 magnetic resonance spectroscopy study in the cat." 12/01/2014 - "Although donor dopamine treatment in brain-dead rats improves renal function and histology in allogeneic recipients, it remains to be assessed if this also holds true for the combinations of BD and prolonged static cold preservation. " 12/01/2014 - "Dopamine treatment of brain-dead Fisher rats improves renal histology but not early renal function in Lewis recipients after prolonged static cold storage." 09/01/2007 - "Dopamine treatment in brain-dead rats mediates anti-inflammatory effects: the role of hemodynamic stabilization and D-receptor stimulation."
4.	Epinephrine (Adrenaline)FDA LinkGeneric 01/01/2008 - "In addition, myocardial sensitization to epinephrine was enhanced following brain death. " 08/15/2000 - "We conclude that epinephrine should be selected as the catecholamine of choice for the management of brain-dead donors." 02/01/1990 - "The required dose of epinephrine to maintain the systemic blood pressure was rather high in the first two days after brain death and could be reduced below 0.1 kg/min in a steady state. " 08/15/2000 - "Epinephrine improved circulatory collapse and pump dysfunction after brain death, while simultaneously maintaining renal perfusion. " 05/01/1986 - "The 10 patients treated with epinephrine alone all succumbed to cardiac arrest within 48 hours of brain death, with a mean survival time of 24.1 +/- 17.2 hours. "
5.	Triiodothyronine (Liothyronine)FDA LinkGeneric 02/01/1990 - "Brain death is associated with neuroendocrine changes, in particular with a significant reduction of plasma-free triiodothyronine (T3) that results in impaired aerobic metabolism. " 01/01/1993 - "Previous studies have documented decreases in serum-free triiodothyronine (T3) after brain death and improved hemodynamics with its replacement, suggesting its controversial, but promising, clinical utility for managing potential organ donors. " 06/01/1993 - "Triiodothyronine treatment in brain-dead multiorgan donors--a controlled study." 02/01/1993 - "Triiodothyronine treatment is not indicated in brain-dead multiorgan donors: a controlled study." 10/01/1992 - "Triiodothyronine treatment in brain-dead multiorgan donors--a controlled study."
6.	barbituric acid (barbiturate)IBA 10/01/1984 - "The patients in each group were further divided into responder and survivor (a), responder but late death (b), and no-responder or acute brain death (c), As far as age of patients concern, 19 out of 26 patients whose age was less than 20, 22 out of 35 patients whose age was 20-50 and 13 out of 23 patients whose age was more than 50 years responded well to the barbiturate therapy. " 06/01/2002 - "In this study, the influence of long continuous administration of barbiturate on diagnosis of brain death was investigated by measuring plasma concentration of barbiturate. " 04/01/2002 - "During the period of the barbiturate infusion and until six days after the suppression of this therapy, neurological exploration and EEG findings seem to confirm brain death, while transcranial Doppler (TCD) study remained normal. " 04/01/1991 - "The study suggests that therapeutic and subtherapeutic barbiturate levels have no effect on the outcome of children who fulfill the criteria for brain death." 01/01/2003 - "[Prolonged clinical pattern of brain death in patients under barbiturate sedation]."
7.	CytokinesIBA 01/01/2005 - "Significant reduction of proinflammatory cytokines by treatment of the brain-dead donor." 01/01/2004 - "Recent studies have shown that brain death upregulates multiple lymphocyte- and macrophage-derived cytokines and the injured brain itself may be the source of proinflammatory factors such as S100B. " 01/01/2013 - "Following brain death, a burst of inflammatory reaction develops; it is characterized by increased plasma levels of cytokines. " 12/01/2009 - "Pretreatment of the rats with BYHWT prior to the induction of rat brain death, can significantly suppress the expressions of inflammatory cytokines and ROS level in the kidneys of rats from BD. " 06/01/2008 - "All cytokines were increased following brain death. "
8.	Messenger RNA (mRNA)IBA 02/01/2014 - "Brain death increases the expression of COX-1 and COX-2 mRNA in the renal medulla. " 01/01/2011 - "CD11b positive macrophages were practically absent from isolated human islets obtained from non-diabetic brain-dead donors, and TLR4 mRNA and cell surface expression were restricted to β-cells. " 07/01/2002 - "We determined the expression of mRNA for 10 inflammatory indicator molecules in hearts from brain-dead animals in which stable circulation was maintained. " 12/01/2007 - "This study was undertaken to investigate liver injury after brain-death in BA-Ma mini pigs and the protective effects of breviscapine on hepatic function and on PKC-alpha mRNA and its protein expression. " 10/15/2010 - "Examination of mRNA levels in lung tissue 5 hr after brain death showed that desensitization of TLR4 limited the expression of interferon (IFN)-γ, IFNβ, and CXCL10, whereas desensitization of TLR2/6 reduced only the expression of IFNγ. "
9.	Technetium Tc 99m Exametazime (Ceretec)FDA Link 07/15/2000 - "In this setting, transcranial Doppler is superior to 99mTc-HMPAO in reducing the waiting time for a firm diagnosis of brain death." 01/01/2000 - "We determined how well the clinical examination criteria held up in the diagnosis of brain death against the new gold standard of Tc-99m HMPAO scintigraphy: Clinical examination criteria correctly predicted brain death only 83% of the time compared with HMPAO scintigraphy. " 10/01/1994 - "These differences and the present study suggest that Tc-99m HMPAO is a superior agent for cerebral perfusion studies to determine brain death." 05/01/1993 - "The results of the Tc-99m HMPAO brain death studies correlated well with the patients' clinical conditions. " 12/01/2004 - "Eight patients who fulfilled the clinical criteria of brain death underwent Tc-99m HMPAO SPECT and electroencephalogram (EEG) monitoring. "
10.	urinastatin (MR 20)IBA 02/01/2003 - "Protective effects of urinary trypsin inhibitor on hepatic microvascular injury in hypotensive brain-dead rats." 07/01/2002 - "Protective effects of urinary trypsin inhibitor (UTI) on hepatic microvasculature in hypotensive brain-dead rats." 03/01/2008 - "The present study examined the effect of urinary trypsin inhibitor (UTI) on liver injury in hypotensive brain-dead rats. " 03/01/2008 - "Urinary trypsin inhibitor improves viability of the liver in brain-dead rats." 11/01/2000 - "Effects of ulinastatin on hypotension and hepatic circulation in brain dead rabbits."

Therapies and Procedures

1.	Transplants (Transplant) 04/01/2009 - "RIB 5/2 treatment significantly improved graft function in recipients of living donor grafts; however, it was not effective in recipients of brain-dead donor organs." 03/01/2006 - "Recipients of organs from brain-dead donors treated with CoPP survived significantly better than those from untreated brain-dead donors (p < 0.05) and intra-graft analysis showed improved histology (p < 0.05). " 05/01/2015 - "Knowledge of the prevalence and natural course of cardiac dysfunction after brain death may help to improve screening and transplant practices but adequately sized studies in pediatric brain death are lacking. " 04/27/2003 - "This study suggests that 3HR treatment of brain-dead donors results in increased numbers of transplanted hearts, with improved short-term graft function." 10/01/2014 - "In liver transplant (LT), the solution developed by the University Of Wisconsin (UW) is the gold-standard to perfuse deceased brain death donor (DBD) grafts. "
2.	Transplantation (Transplant Recipients) 08/01/2015 - "The prevalence of cardiac dysfunction after adult brain death is high, but given enough time and support, many of these donors have improvement in cardiac function, ultimately leading to transplantation." 07/01/1989 - "Hormonal therapy to brain-dead potential organ donors has been shown to lead to metabolic and haemodynamic stability, resulting in no wastage of organs, and in improved function after transplantation." 04/15/2013 - "The present systematic review and meta-analysis was carried out to assess the efficacy of interventions to stabilize hemodynamics in brain-dead donors or to improve organ function and outcomes of transplantation. " 07/01/1996 - "Hearts from brain-dead rats that had received T3 before transplantation showed improved postoperative function. " 01/01/2015 - "In this study we characterized the early inflammatory response induced by brain death in pancreata and islets from nonhuman primate donors and evaluated the effect of targeted anti-inflammatory intervention in the protection of pancreatic islets prior to transplantation. "
3.	Homologous Transplantation (Allograft) 11/04/1991 - "Four advantages of the domino procedure are evident: an increased pool of donor allografts; the use of a heart with an hypertrophied ("prepared") right ventricle; absence of the adverse effects of brain-death in the live donor; and improved ability to match the donor and recipient before the operation." 06/01/2012 - "However, before planning clinical trials in recipients, the start of such a novel therapeutic strategy to prevent allograft rejection could consist of designing and performing a quadruple drug treatment of deceased (brain-dead) donors aimed at generating donor-derived tolerogenic dendritic cells. " 01/15/2009 - "Our Study emphasizes that cold ischemia time should be limited when renal allografts from brain-dead donors are transplanted." 03/03/2004 - "The impact of mode of donor brain death on cardiac allograft vasculopathy: an intravascular ultrasound study." 11/01/2015 - "Survival of Kidney Allograft of Donors after Circulatory Death Is Similar to Donors after Brain Death: Experience in a Regional Program."
4.	Resuscitation 07/01/2014 - "We studied a standardized rodent model of brain death with matched controls to assess the efficacy of DPR as a resuscitation strategy after ABD. " 05/15/2008 - "This study uses a rat model of brain death to determine the profile of PARP activation and whether mechanisms that lead to cell death can be ameliorated by appropriate donor resuscitation. " 05/15/2007 - "Our study shows an impact for only a limited number of brain dead donor resuscitation parameters on DGF duration. " 05/15/2007 - "The aim of this study was to analyze the correlation of DGF >or=6 days with brain-dead donor variables, including those related to resuscitation, in a population of 262 consecutive brain-dead donors from 1990 to 2003. " 01/01/2007 - "This study shows that the resuscitation of brain-dead donors impacts on their renal function. "
5.	Liver Transplantation 02/01/1995 - "Of seven patients with stage 3 encephalopathy, two had rapid deterioration to brain death, three died of nonneurologic causes, and two had a good outcome after liver transplantation. " 11/27/2001 - "Methods to treat the brain-dead donor to improve the quality of the liver may be needed to allow better preservation of the organ and to give better outcome after liver transplantation." 11/01/2014 - "This was a retrospective single-centre study of 76 adults who underwent SLT (right extended lobe) and 301 adults who underwent elective full-size donation after brain death liver transplantation (FSLT). " 01/01/2015 - "We also review the therapeutic strategies designed to date to reduce the detrimental effects of brain death in both marginal and optimal livers, attempting to explain why such strategies have not solved the clinical problem of liver transplantation. " 01/01/2015 - "The effect of brain death in rat steatotic and non-steatotic liver transplantation with previous ischemic preconditioning."