The absence of cerebral blood flow is a valuable adjunct confirming clinical criteria of brain death. However, current methods to confirm absent cerebral blood flow have problems that limit their clinical use. We reviewed cerebral blood flow data obtained with xenon-enhanced computed tomography in nine patients who were being evaluated for brain death. In eight patients who met clinical criteria for brain death, mean cerebral blood flow was 1.6 +/- 2.0 mL X 100 g X min. This value was within the range of error inherent in the method, and therefore represented absent flow. In a patient with persistent respiratory efforts, flow values compatible with absent flow were obtained in the supratentorial compartment, while mean flows as high as 24 mL X 100 g X min were measured in selected regions of interest in the infratentorial compartment, correlating with the clinical evidence of residual function of the brain stem. Xenon-enhanced computed tomography may be a useful test to confirm the absence of cerebral blood flow in patients being evaluated for brain death.