The clinical criteria of brain death throughout the world: why has it come to this?

Abstract

HE addition of neurological criteria of death – better known as brain death – to cardiorespiratory criteria of death was a paradigm shift which evolved when patients with acute brain injury could be resuscitated in emergency departments and intensive care units. Resuscitation of acute brain injury led to progression of devastating brain edema, shift, and eventually massive increase in intracranial pressure that would stop the blood flow at the entrance of the skull base. Multiple symposia were organized in Sweden, the United Kingdom, and Australia that tried to formulate brain death on the basis of neurological criteria. Brain death examination became a prerequisite to allow organ donation, and its concept has been fully accepted. Despite widespread acceptance of the criteria, there remained great variability in how brain death criteria were codified in different parts of the world. A review of the history of neurological death is presented by Baron et al. in this issue of the Journal. 1