Ethical and End-of-Life Issues - Determination of Death using Brain Criteria
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“Brain death” is a legal definition by the Uniform Determination of Death act (UDDA) and can be defined as an irreversible loss of all functions of the brain, including the brain stem. The three pivotal findings for brain death are coma, absent brain stem reflexes, and apnea. A patient who is determined to be brain dead is legally and clinically dead. Several states have adopted amendments regarding physician qualifications and confirmation by second physician for diagnoses of brain death and religious exemption for the diagnosis of brain death. Brain death must be understood to be no different from a diagnosis of death made by cardiac criteria. Practically, the diagnosis of brain death means that a patient can potentially become an organ donor on the conditions of consent and medical acceptability. Locally accepted guidelines are used to establish the diagnosis of brain death. Diagnostic criteria for the clinical diagnosis of brain death in adults, adapted from those used at the Massachusetts General Hospital (MGH), are summarized below. Other institutions may have different criteria. At MGH, brain death may be declared only by an attending neurologist or attending neurosurgeon.