Brain death: resolving inconsistencies in the ethical declaration of death

Abstract

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

Radionuclide Evaluation of Brain Death in the Post-McMath Era

“…Radiographic testing before retrieval of organs from donors who meet clinical brain death criteria might provide conclusive evidence of permanent and irreversible loss of brain function (107), and more-routine use of ancillary brain blood flow analyses might reduce errors (53). A diametrically opposed viewpoint is espoused by Wijdicks, who has suggested that a comprehensive clinical examination, when performed by skilled examiners, should trump any conflicting ancillary examinations (57,97).…”

Clinical death: a diagnosis and a testimony

“…Es también un hecho que existen opiniones divergentes sobre los mismos problemas, todo lo cual pone de manifiesto que el debate aunque con suficiente consenso no deja de estar abierto [21][22][23] . El debate se ha reactivado en los últimos años, especialmente centrado en los aspectos neurológicos sobre la especificidad y selectividad del concepto "muerte encefálica" y sus problemas de aplicación en la práctica [24][25][26][27][28][29][30][31] .…”

Challenges in diagnosing brain death

“…Brain death is a complex concept that is very difficult for the general public to understand. 10,11 Patients and their families place their trust in their treating physician. 12 In organ donation, they trust that physicians will strictly abide by the Dead Donor Rule.…”