The relationship between cessation of brain and systemic circulation after withdrawal of life-sustaining measures
Bibliographic record
Abstract
In donation after circulatory death, it is assumed that cessation of brain activity and brain blood flow occur close to the time of circulatory arrest. However, this assumption lacks direct empirical data that would support current death determination guidelines, ensure donor safety, and maintain public trust. We conducted a single-center prospective observational study of adult patients undergoing controlled withdrawal of life-sustaining measures. We measured systemic circulation using an indwelling arterial cannula and assessed brain blood flow with transcranial Doppler. In a subset of patients, we also recorded brain electrical activity using electroencephalography. Our results demonstrate that brain blood flow consistently stopped before or simultaneously with systemic circulation (median, -179 seconds; range, -458 to 0 seconds; P = .016) and at a higher mean arterial pressure (median, 30 mm Hg; range, 24-36 mm Hg; P = .003) and pulse pressure (median, 13 mm Hg; range, 0-24 mm Hg; P = .006). Among patients with both transcranial Doppler and electroencephalography data, brain activity generally stopped after brain blood flow but before circulatory arrest. These findings support current death determination guidelines, strengthening confidence in donor safety protocols and reinforcing public trust in organ donation.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.015 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".