Cerebral blood flow and cerebral death

At present the diagnosis of cerebral death is based on the absence of manifestations of cerebral function (deep coma, wide pupils, absence of reflexes and spontaneous respiration, isoelectric EEG, etc.) during a variable period of time. However, the absence of vital signs of an organ, even for prolonged periods, is no proof of its death. The death of an organ can only be considered as proved by the demonstration that this organ has remained completely deprived of its blood flow during a period of time that surpasses its ability to survive circulatory arrest. In the case of the brain, the permanent absence of clearance of a radioactive tracer deposed within the brain is considered to demonstrate total absence of flow through it and, thus, to prove cerebral death. As discussed in the text, previous attempts at angiographic “demonstration” of the arrest of cerebral blood flow cannot be accepted uncritically.