Problems in brain death determination.

During the last decade there has been philosophical acceptance of the concept that the state of brain death is equivalent to total patient death. The application of this concept to clinical medicine has been associated with major problems in both the diagnosis of brain death and the medical management of the brain dead patient. In our experience with 176 consecutive cases of suspected brain death over a seven-year period, we have found that a standardized protocol applied by experienced clinicians will minimize these problems.