REVIEW OF CLINICAL CRITERIA OF BRAIN DEATH

Abstract

SummaryA spectrum of descriptive definitions of death has been formulated based on a variety of observations using currently available clinical methods. These definitions vary widely in objectivity and some fail to distinguish the inevitability of death or irreversible coma from the fact of death. A hopeless prognosis may be an adequate criterion for termination of artificial resuscitation, but the bioethical issue involved is one of “passive” euthanasia and not brain death. A hopeless prognosis without a pronouncement of death itself would seem inadequate grounds to remove viable organs for transplantation.When organ donation is contemplated, the declaration of death as a past event must be based on cerebral rather than on cardiovascular criteria. At this point in the history of the art and science of medicine, the highest degree of assurance that the brain is dead may be achieved in the shortest possible time, only by using multiple independently measured variables including clinical criteria, electrophysiologic criteria (the EEG), and assessment of cerebral circulation determined either directly or indirectly. As science and technology improve, the degree of objectivity and facility in obtaining objective criteria will also improve.