Semin Neurol 2008; 28(5): 726-735
DOI: 10.1055/s-0028-1105969
© Thieme Medical Publishers

Withdrawal of Life-Sustaining Therapies and Brain Death in the Intensive Care Unit

Panayiotis N. Varelas1 , Tamer Abdelhak1 , Lotfi Hacein-Bey2
  • 1Departments of Neurology and Neurosurgery, Henry Ford Hospital, Detroit, Michigan
  • 2Departments of Radiology and Neurological Surgery, Loyola University Medical Center, Maywood, Illinois
Further Information

Publication History

Publication Date:
29 December 2008 (online)


The majority of patients who die in intensive care units (ICUs), do so as a result of the withdrawal of life-sustaining treatments or as a result of brain death. With the increasing shortage of transplantable organs, there is growing interest in both these patient populations and their potential for organ donation after cardiac death (DCD) or death by neurological criteria. Therefore, it is imperative for neurologists and neurosurgeons to be familiar with both processes when consulted to evaluate these very sick patients in the ICU. The medicolegal and ethical considerations, the factors that lead to the decision for withdrawal (with special attention to prognostication of the major neurological diseases encountered in an ICU), the process of withdrawal of life-sustaining treatment itself, and the DCD process will be examined. The medicolegal aspects of brain death will also be examined, with particular focus on the process and the various pitfalls and misconceptions.


Panayiotis N Varelas, M.D. , Ph.D. 

Departments of Neurology and Neurosurgery

K-11, Henry Ford Hospital, 2799 West Grand Blvd., Detroit, MI 48202