For cerebral death to occur there must be many levels of cerebral function destroyed. Cortical and subcortical irreversible damage is evident by unresponsiveness to any stimuli. Brain stem and basal ganglia damage is indicated by absence of spontaneous respirations, cephalic reflexes, and thus cerebral circulation. All elements of the criteria for cerebral death must be met. The decision should be made by the attending physician in consultation with his peers. The life support mechanisms should be discontinued after the diagnosis of cerebral death has been made. Absence of pulsatile echoes means absence of cerebral circulation and cerebral function, or a definitive diagnosis of cerebral death. It is a final parameter in the criteria and allows definite measures to be taken. But it behooves one to remember that this phenomenon of cerebral death makes organ donation and transplantation possible. It has not been created in order to supply the needs for organ transplant!