To the Editor.
—The article by Grigg et al in a recent issue of the Archives concluded that the electroencephalogram (EEG) may be a poor confirmatory test for brain death because widespread EEG activity was found in the records of 19.6% of 56 consecutive patients clinically diagnosed as brain dead.We are concerned that the authors' methods for determining apnea were inadequate. Hence, we question whether all, or even most, of their patients met "stringent clinical criteria for brain death," as claimed.Documentation of apnea (indicating absence of the brain-stem respiratory reflex) has always been an essential part of the clinical examination of the suspected brain-dead patient. The authors' clinical criteria for brain death were based principally on the report of the President's Commission on determination of death2 and the brain-death code of the United Kingdom.3 Both of these reports recommend formal apnea tests with 10-minute disconnection times
Belsh JM, Schiffman PL. Electroencephalogram as a Confirmatory Test for Brain Death. Arch Neurol. 1989;46(6):601–602. doi:https://doi.org/10.1001/archneur.1989.00520420019006
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