Skip to main content

Volume 3 Supplement 1


Brain death in a neurologic intensive care unit in turkey


The diagnosis of brain death (BD) is important in order to decrease the burden of futile care and procure vital and viable organs for donation. The aim of this study was to find clinical features of patients, diagnostic tools used, attitude to BD and donation rate in a teaching hospital for neurologic diseases in Istanbul.


All consecutive BD patients between April 2014-April 2015 were included in this retrospective study. Data were abstracted from medical records. Statistical analyses were performed using SPSS software. The results were expressed as percentages for categorical data and median with interquartile range for continuous variables.


Twenty-three patients [10F/13M, age: 63 (54-75)] had BD diagnosis. Neurologic etiologies were ischemic stroke (52%), intracranial bleeding (39%), hypoxic encephalopathy (4.5%) and transverse sinus thrombosis (4.5%). The Glasgow Coma Scales (GCS) were 9 (5-11) at hospital and 7 (5-9) at ICU admission. The clinical sign encouraging the clinicians to think BD were brain stem areflexia (39%), decreased GCS (34.5%), absence of spontaneous breathing (17.5%) and polyuria (9%). BD was suspected first by ICU physicians in 56.5%. BD diagnosis was delayed for > 12 hours in 11 patients because of being sure about BD (46%), legal observation time (27%), sedation (18%) and hemodynamic instability (9%). Fifteen patients had BD diagnosis with apnea and brainstem testing. The remaining 8 cases had confirmatory diagnostic evaluations of BT angiography (6) and EEG (2) due to inability of performing apnea testing (5), clinical suspicion (2) and uncomfortable feeling in giving the decision (1). Apnea testing was reported before neurologic examination in 26%. No complication was documented during apnea testing. Diabetes insipidus was developed in 78% and desmopressin was given to 39% of polyuric patients. Vasopressors were ordered to 95.5% [Noradrenaline (68%), dopamine (18%) and both drugs (14%)] and methylprednisolone [60 (36-60) mg/day] to 57%. Levothyroxine [300 (112-400) mcg] was ordered only one time to 39% during the BD diagnosis period. Three (13%) patients were allowed to be donors by the relatives. The therapy was withdrawn in 55% and held on the present support until cardiac arrest in 35% of the nondonors. No information was found for 10% of the nondonors. The time span from BD confirmation to cardiac arrest developed was 120 (60-636) minutes for the nondonors.


The main clinical signs encouraging the clinicians to identify brain death are brainstem areflexia and decrease in GCS. Apnea and brain stem testing are the major diagnostic approach. Diabetes insipidus and hypotension are commonly encountered situations in these patients.


  1. Shappell CN, Frank JI, Husari K, Sanchez M, Goldenberg F, Ardelt A: Practice variability in brain death determination: a call to action. Neurology. 2013, 81 (23): 2009-14. 10.1212/01.wnl.0000436938.70528.4a.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations


Additional information

Competing interests

No conflict of interest was declared by the authors.

Rights and permissions

Open Access  This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.

The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

To view a copy of this licence, visit

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kurtpınar, Z., Akbaş, T., Şenadım, S. et al. Brain death in a neurologic intensive care unit in turkey. ICMx 3 (Suppl 1), A987 (2015).

Download citation

  • Published:

  • DOI: