Brain Death: Confounders, Testing and Clinical Issues

Part of AACN Critical Care Webinar Series

Presenter(s): Richard Arbour, RN, MSN, CCRN, CNRN, CCNS, CCTC, FAAN

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Webinar Summary

Clinical death as evidenced by the cessation of breathing and heartbeat is understood by patients’ families and providers. However, explaining brain death to nursing colleagues and families can be difficult and fraught with moral distress. In this webinar the presenter will share the clinical definition of brain death and the process of serial assessments and apnea testing. Variables that can confound test results are explored and explained. The causes of movement after brain death and the clinical implications for both the care providers and families will be discussed. A case study format will be used to demonstrate the concepts in the context of actual clinical care.


  • Describe confounders that impact the initiation of brain death testing
  • Identify clinical issues that can arise from movement caused by spinal reflexes, the cardiac cycle, and pulmonary issues
  • Clarify nursing and interprofessional team responsibilities in the determination of brain death




Richard Arbour is a critical care and neuroscience clinical nurse specialist at Lancaster General Hospital/Penn Medicine in Lancaster, Pennsylvania. He has a broad base of 33 years of clinical experience in care of the critically ill patient with a focus on neurologic critical care, identification and management of the potential organ donor and family care at end-of-life. He has authored policies for determination of brain death and is the first to recognize clinically, objectively document and subsequently publish in the nursing literature, the phenomenon of cardiac ventilator triggering in the brain-dead patient as well as provide detailed reviews of practice implications.

Continuing Education Disclosure Statement

Successful Completion

Learners must attend/view/read the entire activity and complete the associated evaluation to be awarded the contact hours or CERP. No partial credit will be awarded.


This activity has been reviewed by the Nurse Planner. It has been determined that the material presented here shows no bias. Approval of a continuing education activity does not imply endorsement by AACN or ANCC of any commercial products displayed or discussed in conjunction with the activity.


The American Association of Critical-Care Nurses (AACN) is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s (ANCC's) Commission on Accreditation, ANCC Provider Number 0012 (60 min contact hour). AACN has been approved as a provider of continuing education in nursing by the California State Board of Nursing, California Provider number CEP01036 for 0.9 contact hours (50 min contact hour).

AACN programming meets the standards for most states that require mandatory continuing education contact hours for license and/or certification renewal. AACN recommends consulting with your state board of nursing or credentialing organization before submitting CE to fulfill continuing education requirements.