Brief review: history, concept and controversies in the neurological determination of death.
OBJECTIVE
Despite general worldwide acceptance of the concept of neurological determination of death (NDD), inconsistencies in clinical criteria and ancillary testing requirements remain. Numerous guidelines for NDD may be applied in clinical practice by a variety of medical practitioners, but the scientific rationale for specific guideline recommendations often remains unclear. This review examines the evolution of NDD, and seeks to provide scientific validation for existing NDD criteria.


METHODS
English language peer-reviewed medical journals and established contemporary medical texts.


RESULTS
Currently published guidelines appear to have evolved from the work of the ad hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death. The Conference of the Royal Colleges and Faculties of the United Kingdom refined the criteria and subsequently adopted the principal of brainstem death. While the fundamentals of NDD guidelines are remarkably consistent worldwide, specific criteria and requirements are often inconsistent.


CONCLUSIONS
Numerous controversies regarding NDD continue to exist, necessitating further scientific clarification of these issues. More recently published guidelines representing the collective opinion of world experts in NDD based upon best current scientific evidence are available in current medical journals.
Baron
Leonard
L
Department of Anesthesia, Misericordia Community Hospital, 16940 - 87 Avenue, Edmonton, Alberta T5R 4H5, Canada. lenbaron@shaw.ca
Shemie
Sam D
SD
Teitelbaum
Jeannie
J
Doig
Christopher James
CJ
D001926:Brain Death / Q000175:diagnosis* / Q000331:legislation & jurisprudence; D001933:Brain Stem / Q000502:physiology; D002170:Canada; D017408:Guidelines as Topic; D049673:History, 20th Century; D006801:Humans; D009460:Neurologic Examination; D009462:Neurology / Q000266:history*