he diagnosis of irreversible loss of brain function (ILBF) means that the patient's brain has irretrievably ceased to function despite the ongoing maintenance of cardiovascular function by the methods of intensive care medicine (Box 1). In §3 of the German Transplantation Law (Transplantationsgesetz, TPG), ILBF is described as "the final, irreversible loss of all function of the cerebrum, cerebellum, and brainstem." The significance of ILBF as a reliable sign of death has been definitively established in Germany (as in other countries) in position statements of multiple involved organizations, including the German Medical Association (Bundesärztekammer) (Box 2), medicalscientific specialty societies, and religious communities (2-8). The basic elements of the determination of ILBF have not changed, and the position statements concerning them are still applicable. The present article, Summary Background: There is an ongoing need for clear explanation of the diagnostic entity called "irreversible loss of brain function" (ILBF), as the absolute reliability of this diagnosis and its significance continue to be widely misunderstood. The determination of death as an objective medical-scientific matter is often not clearly distinguished from various other aspects of death, such as its metaphysical and cultural aspects and the ways in which the living deal with the dead. Method: This review is based on articles retrieved by a selective literature search in the PubMed database and on guidelines and standardized diagnostic protocols from Germany and abroad. Results: ILBF can be caused by brain ischemia or anoxia or by any other type of brain disease or injury leading to an elevation of the intracranial pressure above the blood pressure and thereby to an arrest of the cerebral circulation. All situations in which brain function is merely reduced but not abolished, or only temporarily but not permanently abolished, can be clearly differentiated from ILBF through the use of standard diagnostic procedures as recommended in the relevant guidelines. Biological features that are common to all human beings underlie the medical criteria for the determination of death. The most important elements of the determination of death are irreversibility of the loss of brain function, loss of integration of bodily functions into a single living being, and loss of ability for any self-reflection or any independent interaction with the environment. Conclusion: ILBF is a reliable sign that a human being is dead. There has never been even one known case of incorrect determination of ILBF after proper application of the standardized diagnostic procedures that are set down in the guideline according to §16 of the German Transplantation Law.

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My comment on the article by Brandt and Angstwurm (1) is that much greater value should be placed on spiritual or religious issues than on sober scientific approaches. The question is that of life and death. The fact that an ethics committee has to be summoned in order to decide whether brain death means a person's actual death or not, shows the degree to which human intellectuality has come to overlay our hidden spiritual insights.An article by Walter van Laack (2) explains how research results of near-death experiences imply that a consciousness exists that is independent of the brain and possibly survives a person's death. We can certainly assume that the entire complexity of near-death experiences is cannot be explained in terms of neurophysiology. Today's medical scientists are aware that consciousness exists independently of brain function. We can therefore conclude that a brain dead human body is not a corpse.An article by Cathrin Marshall (3) makes apparent the enormous emotional stress that a transplant team is under when a brain-dead body is opened up from the jugular vein to the pubal symphysis, and the organs are explanted from the hollow basin thus created.Intuition is a result of psychological-spiritual experiences and cannot be taught. Human beings require time to reach spiritual decisions, especially when crucial decisions-such as organ donation-are concerned.The opt-out system for organ donation interferes massively with the spiritual decision-finding process. It is a psychological assault and for this reason should be strictly rejected on moral grounds.

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