Knowledge gaps in the definition and determination of death

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

“…More recently, Maitre and Shemie enumerated scientific and practical research questions about BD/DNC as pertains to: worldwide variance in BD/DNC determination; BD/DNC demographics; the BD/DNC examination and apnea testing; the number of BD/DNC evaluations; neuroendocrine secretion after BD/DNC; special considerations related to BD/DNC determination in patients with HIBI, primary infratentorial injury, after surgical interventions to decrease ICP or in the pediatric population; neuroimaging; ancillary testing; the aftermath of BD/DNC determination; and recovery of brain function after BD/DNC. 247 248 They noted that research after BD/DNC is feasible and family consent rate has been as high as 90% in some studies. To advance knowledge related to BD/DNC, they suggested: development of infrastructure and funding policies for this research, creation of registries related to all aspects of BD/DNC determination, engagement of the public, and attention to underrepresented populations and minority groups.…”

Nontherapeutic research with imminently dying and recently deceased study populations: addressing practical and ethical challenges

“…For example, a study to document cerebral blood flow and cerebral electrical activity in relation to arterial pulse pressure following withdrawal of life-sustaining measures is needed to determine when cessation of brain function occurs during the dying process. 2 …”

“… 1 In generating its recommendations, the guideline development group identified numerous knowledge gaps. 2 Many of these suggest research questions answerable only through nontherapeutic studies involving imminently dying or recently deceased adult and pediatric patients in controlled intensive care unit environments.…”

Relever les défis mondiaux liés à la détermination du décès : le leadership canadien en matière de création de consensus

“…Specific papers highlight the strengths and limitations of current guidance, evidence, research, and practice in the determination of death for both adults and young children. [44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60] Of equal importance are papers exploring family and societal understanding and acceptance of death determination criteria, [61][62][63][64] and the implications of a brain-based definition of death from a legal and cultural perspective. [65][66][67] Conclusion Some phenomena move forward with time, some do not.…”

“…Cette collection aidera a `re ´pondre aux de ´fis mondiaux et propres au Canada en matie `re de de ´termination du de ´ce `s. Certains articles spe ´cifiques soulignent les forces et les limites des lignes directrices, des donne ´es probantes, de la recherche et de la pratique actuelles dans la de ´termination du de ´ce `s chez les adultes et les jeunes enfants. [44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60] Tout aussi importants sont les articles explorant la compre ´hension et l'acceptation par la famille et la socie ´te ´des crite `res de de ´termination du de ´ce `s, [61][62][63][64] ou encore les implications d'une de ´finition ce ´re ´brale du de ´ce `s d'un point de vue juridique et culturel. [65][66][67]…”