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Medicine and Public Policy |

Brain Death: Reconciling Definitions, Criteria, and Tests

Amir Halevy, MD; and Baruch Brody, PhD
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From Baylor College of Medicine, Houston, Texas. Requests for Reprints: Amir Halevy, MD, General Medicine Section, Ben Taub General Hospital, 1504 Taub Loop, Houston, TX 77030. Acknowledgments: The authors thank Robert Arnold, MD, and Stuart Youngner, MD, for advice and support.

Copyright 2004 by the American College of Physicians

Ann Intern Med. 1993;119(6):519-525. doi:10.7326/0003-4819-119-6-199309150-00013
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Brain death has been discussed extensively for the last 25 years. Most investigators now believe that requiring death of the entire brain as the criterion for brain death in the Uniform Determination of Death Act and the standard clinical tests of brain death outlined in the Report of the Medical Consultants to the President's Commission have produced a satisfactory resolution of the issues surrounding the determination of death. However, we show that satisfying the standard medical tests does not guarantee that all brain functions have actually ceased and that there is tension between the legal criterion and the standard clinical tests. After considering and rejecting six possible reconciliations, we present an alternative approach that does not acknowledge any sharp dichotomy between life and death and incorporates the proposition that the questions of when care can be unilaterally discontinued, when organs can be harvested, and when a patient is ready for the services of an undertaker should be answered independent of any single account of death.


brain death ; brain





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