Brain Death: Reconciling Definitions, Criteria, and Tests

Halevy, Amir; Brody, Baruch A.

doi:10.7326/0003-4819-119-6-199309150-00013

Cited by 203 publications

(76 citation statements)

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“…Many patients diagnosed as brain dead have intact neurohumoral control of hypothalamic-pituitary function, demonstrate normal hypothalamic mediated thermoregulatory control, and have intact autonomic function: they do not have hemodynamic collapse, they have physical findings such as bowel sounds, and are reported to have autonomic reflexes (tachycardia and hypertension) at the time of organ retrieval. 12 Thermoregulatory control, maintenance of normal hypothalamus and pituitary gland function, and intact autonomic function represent normal subcortical functions inconsistent with the understanding of 'permanent cessation of functioning of the entire brain'. Given that current clinical testing does not assess subcortical brain function, 'whole brain death' cannot be conclusively identified at the bedside by using clinical criteria.…”

Section: Resultsmentioning

confidence: 99%

Brain death: resolving inconsistencies in the ethical declaration of death

Doig¹,

Burgess

2003

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : The first criteria for the determination of brain death were developed in 1968 in part to address concerns that had arisen with the retrieval of organs for transplantation. Despite over 30 years of application, some professional and public doubt persists over the validity of the theoretical construct underlying this method of determining death. Our review will address historical perspectives on the development of brain death criteria, and inconsistencies in current clinical criteria.M Me et th ho od d: : Narrative review from selected MEDLINE references and other published sources.P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : The primary construct of the determination of death is that either cardiopulmonary or neurological function irreversibly ceases. However, there is inconsistency in the neurological criteria for death between jurisdictions, between patient populations, and in the use of confirmatory tests. These inconsistencies may cause concern in the public or profession about the validity of the determination of death by neurological criteria.C Co on nc cl lu us si io on ns s: : Organ transplantation is premised on professional and public acceptance that the donor is dead. Given that the criteria for brain death or their application remain variable, we suggest that it is reasonable to consider a national consensus to address these inconsistencies. Alternatively, the standard use of confirmatory radiographic testing prior to the retrieval of organs from donors who meet clinical brain death criteria should be considered to provide conclusive evidence of permanent and irreversible loss of brain function. Objectif

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Section: Resultsmentioning

confidence: 99%

Brain death: resolving inconsistencies in the ethical declaration of death

Doig¹,

Burgess

2003

Can J Anesth/J Can Anesth

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“…This is also reflected in the literature, in view of the extensive resumption of the discussion of death as a process [16][17][18][19] . In a very general way, it can be said that death begins at birth.…”

Section: What Is Death?mentioning

confidence: 98%

Morte encefálica: uma discussão encerrada?

Filho

Junges

2015

Rev. Bioét.

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This article is a narrative review of the main authors who establish objections to the use of the concept of brain death as a synonym for death. It focuses on their biological and philosophical inconsistencies of the concept and proposes the discussion of the topic using the epistemological concepts of Popper and Kuhn. The article adopts the concepts of biopower and biopolitics as tools in the analysis of brain death, especially in relation to the inevitable intersection with organ donation and transplants. Keywords: Brain death. Bioethics. Transplantation. ResumoMorte encefálica: uma discussão encerrada? O presente artigo faz revisão narrativa dos principais autores que estabelecem objeções à utilização do conceito de morte encefálica como sinônimo de morte, com foco em suas inconsistências biológicas e filosóficas. Propõe a discussão do tema recorrendo aos conceitos epistemológicos de Popper e Kuhn. Utiliza os conceitos de biopoder e biopolítica como ferramentas de análise da morte encefálica, especialmente no que concerne a sua inevitável intersecção com a doação e transplantes de órgãos. Palavras-chave: Morte encefálica. Bioética. Transplante. Resumen Muerte cerebral: ¿una discusión cerrada?Este artículo es una revisión narrativa de los principales autores que establecen excepciones a la utilización del concepto de muerte cerebral como sinónimo de muerte, centrándose en sus inconsistencias biológicas y filosóficas. Se propone la discusión del tema usando los conceptos epistemológicos de Popper y Kuhn. Utiliza los conceptos de biopoder y de biopolítica como herramientas en el análisis de la muerte cerebral, especialmente en relación con la intersección inevitable con los trasplantes de donación de órganos. Palavras-clave: Muerte encefálica. Bioética. Transplante.

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“…Note that during the years preceding John Paul II's 2000 address, the academic literature was not lacking in scholarly publications pointing out the numerous inconsistencies of the "whole brain death paradigm"; and this, in itself, was an indicator of a lack of consensus about the "brain death" concept. See, for example, Youngner (1992), Halevy and Brody (1993), Veatch (1993), Robert Taylor (1997), andTruog (1997). At the same time, the medical literature was not lacking in reports of patients who met all the criteria of "whole brain death," but did not undergo organ explantation and continued to live on for months.…”

Section: The 1968 Harvard Ad Hoc Committeementioning

confidence: 99%

Pope John Paul II and the Neurological Standard for the Determination of Death: A Critical Analysis of his Address to the Transplantation Society

Nguyen

2017

Linacre Q

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The introduction of the “brain death” criterion constitutes a significant paradigm shift in the determination of death. The perception of the public at large is that the Catholic Church has formally endorsed this neurological standard. However, a critical reading of the only magisterial document on this subject, Pope John Paul II's 2000 address, shows that the pope's acceptance of the neurological criterion is conditional in that it entails a twofold requirement. It requires that certain medical presuppositions of the neurological standard are fulfilled, and that its philosophical premise coheres with the Church's teaching on the body-soul union. This article demonstrates that the medical presuppositions are not fulfilled, and that the doctrine of the brain as the central somatic integrator of the body does not cohere either with the current holistic understanding of the human organism or with the Church's Thomistic doctrine of the soul as the form of the body. Summary The concept of “brain death” (the neurological basis for legally declaring a person dead) has caused much controversy since its inception. In this regard, it has been generally perceived that the Catholic Church has officially affirmed the “brain death” criterion. The address of Pope John Paul II in 2000 shows, however, that he only gave it a conditional acceptance, one which requires that several medical and philosophical presuppositions of the “brain death” standard be fulfilled. This article demonstrates, taking into consideration both the empirical evidence and the Church's Thomistic anthropology, that the presuppositions have not been fulfilled.

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Brain Death: Reconciling Definitions, Criteria, and Tests

Cited by 203 publications

References 0 publications

Brain death: resolving inconsistencies in the ethical declaration of death

Brain death: resolving inconsistencies in the ethical declaration of death

Morte encefálica: uma discussão encerrada?

Pope John Paul II and the Neurological Standard for the Determination of Death: A Critical Analysis of his Address to the Transplantation Society

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