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August 5, 1983

Diagnosis of Brain Death

Author Affiliations

President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research Washington, DC

JAMA. 1983;250(5):612. doi:10.1001/jama.1983.03340050024010

To the Editor.—  Radionuclide cerebral imaging (RCI) has been well established as a confirmation of brain death.1-3 However, the proved utility of the procedure is overstated in the recent article by Schwartz et al (1983; 249:246), largely because it confuses cerebral blood flow with intracranial. Also, the authors overstate the importance of demonstrating correlation between two tests in a selected population of patients.Documentation of absent intracranial blood flow can at present only be achieved by four-vessel contrast angiography, which examines blood flow to both the cerebrum and the posterior fossa. This study, repeated to show persistence for a period (ten minutes is recommended), is unequivocal evidence of "irreversible cessation of all functions of the entire brain"—brain death—even if circumstances preclude determination of cause or a comprehensive neurological examination.However, the same cannot be said for a test such as RCI that evaluates only cerebral blood flow, not posterior