Building a Fence Around Brain Death

Abstract

The concept of brain death was proposed more than 50 years ago, and it has been incorporated in laws and clinical practice, but it remains a source of confusion, debate, and litigation. Because of persistent variability in clinical standards and ongoing controversies regarding policies, the Uniform Law Commission, which drafted the Uniform Determination of Death Act in 1980, has appointed a committee to study whether the act should be revised. This article reviews the history of the concept of brain death and its philosophical underpinnings, summarizes the objections that have been raised to the prevailing philosophical formulations, and proposes a new formulation that addresses those objections while preserving current practices.

An Update on Brain Death/Death by Neurologic Criteria since the World Brain Death Project

“…In 2021, Gelb proposed the “shielded-brain” formulation which defined BD/DNC as irreversible loss of consciousness due to a condition known to affect both the cortex and brainstem in the setting of loss of all brainstem reflexes, including the ability to breathe spontaneously. 82 Finally, the “brain-as-a-whole” formulation has gained traction since publication of the WBDP. 66 83 84 85 86 This modification of the “whole brain” formulation focuses on the essential elements of loss of brainstem and cerebral hemispheric function, but permits neuroendocrine secretion.…”