Controversies in defining and determining death in critical care

@article{Bernat2013ControversiesID,
  title={Controversies in defining and determining death in critical care},
  author={James L. Bernat},
  journal={Nature Reviews Neurology},
  year={2013},
  volume={9},
  pages={164-173}
}
  • J. Bernat
  • Published 1 March 2013
  • Medicine, Biology, Psychology
  • Nature Reviews Neurology
Circulatory–respiratory or brain tests are widely accepted for definition and determination of death, but have several controversial issues. Both determinations have been stimulated by organ donation, but must be valid independently of this process. Current controversies in brain death include whether the definition is conceptually coherent, whether the whole-brain or brainstem criterion is correct, whether one neurological examination or two should be required, and when to conduct the… 
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References

SHOWING 1-10 OF 139 REFERENCES
Contemporary controversies in the definition of death.
  • J. Bernat
  • Medicine, Biology
    Progress in brain research
  • 2009
The circulatory–respiratory determination of death in organ donation*
TLDR
The use of unmodified extracorporeal membrane oxygenation in the circulatory determination of death donor after death is declared should be abandoned because, by restoring brain circulation, it retroactively negates the previous death determination.
Variability in the Determination of Death After Cardiac Arrest
TLDR
This review is the first to document the variability in specific criteria, diagnostic tests, and recommended wait periods for the determination of death after cardiac arrest, in countries where the practice of DCDD is becoming increasingly common.
Pitfalls in the Diagnosis of Brain Death
TLDR
Every step in the determination of brainDeath bears potential pitfalls which can lead to errors in the diagnosis of brain death, and possible solutions are identified.
How can we achieve uniformity in brain death determinations?
This year marks the 40th anniversary of the publication of the landmark Harvard Medical School Ad Hoc Committee report that established brain death as an accepted medical phenomenon.1 Therefore, it
The Incoherence of Determining Death by Neurological Criteria: A Commentary on Controversies in the Determination of Death, A White Paper by the President’s Council on Bioethics
TLDR
According to the position of this committee, patients diagnosed with the cessation of brain function are dead, despite the fact that they breathe and circulate blood with the aid of mechanical ventilation.
Guidelines for the determination of brain death in infants and children: An update of the 1987 Task Force recommendations*
TLDR
The 1987 pediatric brain death guidelines were reviewed and revised and recommendations were developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.
The Whole-Brain Concept of Death Remains Optimum Public Policy
  • J. Bernat
  • Medicine
    Journal of Law, Medicine & Ethics
  • 2006
The definition of death is one of the oldest and most enduring problems in biophilosophy and bioethics. Serious controversies over formally defining death began with the invention of the
Brain Death: Reconciling Definitions, Criteria, and Tests
TLDR
The Uniform Determination of Death Act provided the legal articulation of the whole-brain criterion of death as irreversible cessation of all functions of the brain, including the brainstem.
Donation after cardiocirculatory death in Canada
TLDR
It is recommended that programs begin with controlled DCD within the intensive care unit where (after a consensual decision to withdraw life-sustaining therapy) death is anticipated, but has not yet occurred, and unhurried consent discussions can be held.
...
...