Single institution experience with death by neurological criteria/brain death guideline adherence

•The use of a checklist improved protocol adherence for diagnosis of death by neurologic criteria/brain death and did not increase time to declaration of death.•Metabolic and toxic confounders are common to encounter in patients who progress to death by neurologic criteria/brain death.•The clinical diagnosis of death by neurologic criteria/brain death is commonly limited by the inability to complete apnea testing, and these cases require appropriate ancillary testing.