Diagnosing Death using Neurological Criteria

In 2021 in the UK, a diagnosis of death using neurological criteria, had to be reversed. The case concerned bilateral therapeutic decompressive craniectomy as a treatment for severe traumatic brain injury. An expert group reviewed the case and made recommendations, which have been accepted by the Faculty and Intensive Care Society.

The main recommendation was that ‘Therapeutic decompressive craniectomy’ should be added as a red flag to the nationally endorsed testing forms.

During the review the expert group used the opportunity to improve the nationally endorsed testing forms by:

  • Giving more prominence to the red flags to ensure they are seen and accounted for.
  • Specifically, advising that clinicians should consider the need to delay testing and/or perform ancillary investigations if a red flag is identified.
  • Enhancing clarity and emphasis. This included removing symbols for greater or lesser than in the testing form questions.

The diagnosis of death using neurological criteria is an important diagnosis. In the UK, the diagnosis is made almost exclusively by intensive care doctors.

The forms below are consistent with and should be used in conjunction with, the AoMRC Code of Practice for the Diagnosis and Confirmation of Death (2008).

We would ask that you update older versions of the nationally endorsed forms with updated versions.

FICMPAS has also produced supplementary guidance is for the Diagnosis of Death using Neurological Criteria when the patient is supported with extracorporeal membrane oxygenation (ECMO) - this is available below.

The NHS Blood and Transplant website also has educational videos available on this topic.