Abstract
Despite well-described international variabilities in brain death practices, de facto
there already exists a minimum international clinical standard for the diagnosis of
brain death. This remains rooted in the Harvard criteria and based on the characteristics
of a permanently nonfunctioning brain. Medicine is evolving toward a single unified
determination of death based on the cessation of brain function subsequent to catastrophic
brain injury or circulatory arrest. Clarity in lexicon could be established, including
movement toward functional definitions and away from anatomically based terms such
as cardiac and brain death that erroneously imply death of the organ. The cessation
of clinical functions of the brain that will not resume is determined by the absence
of capacity for consciousness, centrally mediated motor responses, brainstem reflexes,
and capacity to breathe. A known proximate cause and the absence of confounding or
reversible conditions must be confirmed. Regional medical, legal, cultural, religious,
or socioeconomic factors may require testing beyond this minimal clinical standard.
Keywords
brain death - international consensus - death determination - organ donation
