Background Transcranial Doppler (TCD) detects characteristic waveforms indicating cerebral circulatory arrest and has been widely applied as an ancillary test for adult brain death or death by neurologic criteria. However, its application in children remains controversial due to anatomical differences and limited evidence. This review outlines the current role of transcranial Doppler in confirming pediatric brain death or death by neurologic criteria, offering practical insights and directions for future research. Methods A literature review was conducted on the use of transcranial Doppler to confirm pediatric brain death or death by neurologic criteria. This included original studies, meta-analyses, reviews, clinical guidelines, consensus statements, position papers, and legislation. Databases searched included PubMed, Embase, Cochrane Library, Web of Science, Google Scholar, China National Knowledge Infrastructure and Wanfang, covering records from inception to July 5, 2025. Search terms included “transcranial Doppler”, “TCD”, “cerebral circulatory arrest”, “death by neurologic criteria”, and “brain death”. Results The use of transcranial Doppler varies across countries for confirming pediatric brain death or death by neurologic criteria. Some recommend transcranial Doppler, while others do not. Diagnostic criteria, including vessel selection, interpretation of absent blood flow signals and the number of tests, also vary. Pediatric studies support the clinical value of transcranial Doppler in the determination of brain death or death by neurologic criteria, but small sample sizes, methodological inconsistencies, and false results due to hemodynamic instability, open fontanelles or skull defects limit firm conclusions. Transcranial color-coded Doppler may improve diagnostic accuracy in certain cases. Conclusions Transcranial Doppler demonstrates considerable potential in confirming pediatric brain death or death by neurologic criteria, particularly in resource-limited or bedside settings. Given the current variability in clinical practice and the limitations of existing evidence, further large-scale, prospective studies are warranted to validate its role in this indication. Graphical abstract

Use of transcranial Doppler to determine brain death or death by neurologic criteria in children: a narrative review

期刊论文
发表日期：

2026年1月29日

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Na Tan,
Jie Wu,
Su-Yun Qian

摘要

Background

Transcranial Doppler (TCD) detects characteristic waveforms indicating cerebral circulatory arrest and has been widely applied as an ancillary test for adult brain death or death by neurologic criteria. However, its application in children remains controversial due to anatomical differences and limited evidence. This review outlines the current role of transcranial Doppler in confirming pediatric brain death or death by neurologic criteria, offering practical insights and directions for future research.

Methods

A literature review was conducted on the use of transcranial Doppler to confirm pediatric brain death or death by neurologic criteria. This included original studies, meta-analyses, reviews, clinical guidelines, consensus statements, position papers, and legislation. Databases searched included PubMed, Embase, Cochrane Library, Web of Science, Google Scholar, China National Knowledge Infrastructure and Wanfang, covering records from inception to July 5, 2025. Search terms included “transcranial Doppler”, “TCD”, “cerebral circulatory arrest”, “death by neurologic criteria”, and “brain death”.

Results

The use of transcranial Doppler varies across countries for confirming pediatric brain death or death by neurologic criteria. Some recommend transcranial Doppler, while others do not. Diagnostic criteria, including vessel selection, interpretation of absent blood flow signals and the number of tests, also vary. Pediatric studies support the clinical value of transcranial Doppler in the determination of brain death or death by neurologic criteria, but small sample sizes, methodological inconsistencies, and false results due to hemodynamic instability, open fontanelles or skull defects limit firm conclusions. Transcranial color-coded Doppler may improve diagnostic accuracy in certain cases.

Conclusions

Transcranial Doppler demonstrates considerable potential in confirming pediatric brain death or death by neurologic criteria, particularly in resource-limited or bedside settings. Given the current variability in clinical practice and the limitations of existing evidence, further large-scale, prospective studies are warranted to validate its role in this indication.

Graphical abstract