title: Brain death: resolving inconsistencies in the ethical declaration of death.
abstract: OBJECTIVE
  The first criteria for the determination of brain death were developed in 1968 in part to address concerns that had arisen with the retrieval of organs for transplantation. Despite over 30 years of application, some professional and public doubt persists over the validity of the theoretical construct underlying this method of determining death. Our review will address historical perspectives on the development of brain death criteria, and inconsistencies in current clinical criteria.
  
  
  METHODS
  Narrative review from selected MEDLINE references and other published sources.
  
  
  RESULTS
  The primary construct of the determination of death is that either cardiopulmonary or neurological function irreversibly ceases. However, there is inconsistency in the neurological criteria for death between jurisdictions, between patient populations, and in the use of confirmatory tests. These inconsistencies may cause concern in the public or profession about the validity of the determination of death by neurological criteria.
  
  
  CONCLUSIONS
  Organ transplantation is premised on professional and public acceptance that the donor is dead. Given that the criteria for brain death or their application remain variable, we suggest that it is reasonable to consider a national consensus to address these inconsistencies. Alternatively, the standard use of confirmatory radiographic testing prior to the retrieval of organs from donors who meet clinical brain death criteria should be considered to provide conclusive evidence of permanent and irreversible loss of brain function.
authors.affiliation: Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada. cdoig@ucalgary.edu
authors.forename: Christopher James
authors.initials: CJ
authors.lastname: Doig
authors.forename: Ellen
authors.initials: E
authors.lastname: Burgess
mesh_terms: D001926:Brain Death / Q000175:diagnosis* / Q000331:legislation & jurisprudence; D004992:Ethics, Medical; D006801:Humans; D016377:Organ Transplantation / Q000941:ethics*; D017410:Practice Guidelines as Topic