Progress in legal definition of brain death and consent to remove cadaver organs

The availability of cadaver kidneys for transplantation falls far short of the needs of a rapidly expanding population of patients on chronic hemodialysis. Kidneys with the least ischemic injury come from donors with fatal head injury or stroke; such kidneys can be removed from a "beating-heart" cadaver after declaring death on the basis of brain death. To clarify the legal status of brain death and to encourage salvage of transplantable kidneys with minimal ischemic injury, 12 states already have codified the concept of brain death. Although the first few laws were lengthy and included medical terms, six of the last seven laws have used one or two models proposed by the American Bar Association (ABA) and the Institute of Society, Ethics and Life Sciences, Hastings-on-Hudson, N. Y. The ABA proposal is the simpler of the two models and should provide the basis for future state laws. In addition, the National Conference of Commissioners on Uniform State Laws plans to present a model law to define death and the liabilities of a physician who declares death on the basis of brain death by mid 1977. While state legislatures have written laws that establish the legality of the concept of brain death, medical groups have sought to define the medical criteria for its determination. The most recent list of criteria comes from a National Institutes of Health-supported Collaborative Study on Cerebral Survival, as follows: (1) unresponsivity, (2) apnea, (3) dilated pupils and absent cephalic reflexes, (4) electrocerebral silence, (5) a confirmatory test of absent cerebral blood flow (angiography, isotope bolus curve, retinoscopy, or echoencephalography).