The Role of Interdisciplinary ICU Team in Complex Brain Death Determination

Background Brain death (BD) represents the irreversible cessation of all brain function, including the brainstem, and is a critical determination in end-of-life care. The neurological assessment remains the cornerstone of BD diagnosis, with the apnea test playing a pivotal role. However, when an apnea test can be done due to patient instability, ancillary testing, such as radionuclide cerebral perfusion scans (RCPS), is often used. Despite their utility, false negative RCPS results can create ethical and clinical challenges in BD determination and end-of-life decision-making. Case Summary: We present a case where RCPS produced a false negative result for brain death despite the consistent absence of all brainstem reflexes. This discordance complicated prognostication and delayed discussions on the compassionate withdrawal of life-sustaining therapy. Conclusion Interdisciplinary collaboration between intensivists, neurologists, and palliative specialists plays a key role in navigating the complex intersection between BD diagnosis, prognostication, and ethical decision-making. Given the potential for false negative RCPS findings, BD diagnosis must remain anchored in clinical assessment. Reliance on discordant ancillary testing risks delaying essential palliative care interventions and prolonging non-beneficial treatments.