Advanced directives related to life-sustaining measures, such as full code or do-not-resuscitate orders, are only relevant in living patients;
irrelevant once brain death is diagnosed.
presence of cardiac activity and spontaneous or reflex motor responses as a result of bioelectrical activity restricted to the spinal cord, peripheral nerves, and muscles
exclude confounders (e.g., sedative/paralytic use, severe metabolic derangements, hypotension),
the patient is comatose, does not have brain-mediated motor responses (e.g., decorticate posturing, facial grimacing), has brainstem areflexia, and has a positive apnea test.
independently verified by another physician.
Once brain death is confirmed for such a patient, all forms of life support including mechanical ventilation are futile and consent from an SDM is not required to discontinue life support as the patient is legally dead.
surrogate decision-maker (SDM)
life support can be continued for a short while so that they can say their goodbyes.
life support should be discontinued right away.
Advanced directives related to resuscitation (e.g., full code) are irrelevant once brain death is diagnosed.
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