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Circulatory Arrest, Brain Arrest and Death Determination.
Sam David Shemie1,2, Dale Gardiner3,4
1Division of Critical Care, Montreal Children's Hospital, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
Frontiers in Cardiovascular Medicine
|April 18, 2018
Summary
Technological advancements challenge traditional definitions of death. This paper proposes permanent brain arrest, not cardiac death, as the sole criterion for determining death, emphasizing the brain
Area of Science:
- Medical Ethics
- Neuroscience
- Critical Care Medicine
Background:
- Organ support and transplantation technologies challenge existing definitions of death.
- The ability to reanimate organs challenges the validity of concepts like cardiac death.
Purpose of the Study:
- To propose a unified conceptual determination of death.
- To establish permanent brain arrest as the sole criterion for death.
Main Methods:
- Review of technological advancements in organ support and reanimation.
- Analysis of the physiological consequences of circulatory arrest on the brain.
- Clinical characterization of brain arrest.
Main Results:
- Traditional concepts of organ death, such as cardiac death, are invalidated by current technology.
- Permanent brain arrest, characterized by irreversible loss of consciousness and brainstem function, is proposed as the definitive marker of death.
- In circulatory arrest, death is determined by cessation of brain circulation, not cardiac function.
Conclusions:
- A single conceptual determination of death based on permanent brain arrest is advocated.
- This framework accommodates technological advancements and refines the understanding of death.
- Interventions restoring brain circulation after arrest would invalidate a death determination.
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