The lack of scientific evidence in clinical practice guideline in brain death determination: Implications for organ donation and transplantation.

Abstract

Human death is universally understood to be a biological phenomenon, that is, the irreversible loss of the body's ability to mitigate entropy. Technological advances in transplantation medicine created the problem of optimally managing the supply of and demand for viable organs. We have previously outlined how irreversible apneic coma was introduced as a criterion of death and was approved by the US President's Commission in 1981.[1] The Uniform Determination of Death Act (UDDA) enacted two alternative methods in death determination: (1) Irreversible cessation of circulatory and respiratory functions; or (2) irreversible cessation of all functions of the entire brain, including the brainstem.[1] Other countries have adopted the brainstem definition of death. Most jurisdictions have followed the US legislation. Existing laws already disallow the act of procurement to be the proximate cause of the donor's death, reflecting a deontological moral premise that, in the context of organ donation, is referred to as the dead donor rule (DDR). Different cultures and religions do not object to organ donation if and only if vital organs are procured from cadavers and thus, in compliance with the DDR. The legal and moral legitimacy of procuring organs after determination of death with brain-based criteria, that is, brain death (BD) is centered on its equivalency with biological death. The concept of BD has serious shortcomings in this regard: (1) equivalency with biological death cannot be substantiated by contemporary neuroscience; (2) standard practice guideline for BD diagnosis is based only on weak scientific evidence, and (3) the biophilosophical explanation to equate BD and human death lacks logical coherence.