'Brain death': should it be reconsidered?

Area of Science:

• Neuroscience
• Medical Ethics
• Legal Medicine

Background:

• The diagnosis of brain death is critical for end-of-life care and organ donation.
• Current clinical criteria and confirmatory tests are widely used but their scientific basis is debated.

Purpose of the Study:

• To critically evaluate the adequacy of existing clinical criteria and confirmatory tests for diagnosing irreversible cessation of all brain functions, including the brainstem.
• To assess whether the concept of brain death accurately reflects the irreversible loss of entire brain function.

Main Methods:

• Comprehensive review of medical, philosophical, and legal literature concerning brain death.
• Analysis of arguments challenging the assumption of complete and irreversible loss of brain function in clinically brain-dead patients.

Main Results:

• Patients meeting brain death criteria may exhibit residual vegetative functions coordinated by the brainstem.
• Clinical examination limitations hinder assessment of cerebral function and internal awareness.
• Stereotyped movements may originate from the brainstem, challenging complete cessation.
• Current confirmatory tests lack sufficient positive predictive value for reliably pronouncing death.

Conclusions:

• The assumption of irreversible cessation of all brain or brainstem functions in brain-dead patients is not fully supported.
• The current concept and diagnostic criteria for brain death require re-evaluation and reconsideration.