Dilated Pupils and Brain Death

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To the Editor: In their interesting and important study, Fraser and Arieff (1) thrice mention that the finding of fixed, dilated pupils suggested the diagnosis of brain death, and they further imply that the diagnosis of brain death may have been incorrect. These statements deserve comment.

Fully dilated pupils are evidence of preserved sympathetic outflow and are incompatible with the diagnosis of brain death as it is commonly understood (2). The pupils of the brain-dead patient are midposition (4 to 6 mm in diameter) and fixed to light (3). Although the original statement of the "Harvard" criteria included the requirement