title: Changing the conversation about brain death.
abstract: We seek to change the conversation about brain death by highlighting the distinction between brain death as a biological concept versus brain death as a legal status. The fact that brain death does not cohere with any biologically plausible definition of death has been known for decades. Nevertheless, this fact has not threatened the acceptance of brain death as a legal status that permits individuals to be treated as if they are dead. The similarities between "legally dead" and "legally blind" demonstrate how we may legitimately choose bright-line legal definitions that do not cohere with biological reality. Not only does this distinction bring conceptual coherence to the conversation about brain death, but it has practical implications as well. Once brain death is recognized as a social construction not grounded in biological reality, we create the possibility of changing the social construction in ways that may better serve both organ donors and recipients alike.
authors.affiliation: a Boston Children's Hospital and Harvard Medical School.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Truog
authors.forename: Franklin G
authors.initials: FG
authors.lastname: Miller
mesh_terms: D000293:Adolescent; D000328:Adult; D001766:Blindness; D001926:Brain Death / Q000331:legislation & jurisprudence*; D001930:Brain Injuries / Q000209:etiology; D005260:Female; D006801:Humans; D007258:Informed Consent / Q000941:ethics / Q000331:legislation & jurisprudence / Q000592:standards; D008297:Male; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy; D011640:Public Policy; D011655:Pulmonary Embolism / Q000150:complications; D020858:Tissue and Organ Harvesting / Q000941:ethics / Q000331:legislation & jurisprudence; D009927:Tissue and Organ Procurement / Q000941:ethics / Q000331:legislation & jurisprudence; D014068:Tonsillectomy / Q000009:adverse effects; D014481:United States; D028761:Withholding Treatment / Q000941:ethics / Q000331:legislation & jurisprudence
keywords: brain death; dead donor rule; definition of death; health policy; organ donation; organ transplantation