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Brief review: History, concept and controversies in the neurological determination of death

[Revue sommaire : histoire, concept et discussion de la détermination neurologique de la mort]

Leonard Baron, MD^*, Sam D. Shemie, MD, Jeannie Teitelbaum, MD and Christopher James Doig, MD MSc

^* From the Department of Anesthesia, Misericordia Community Hospital, University of Alberta, Edmonton, Alberta; the
Division of Critical Care Medicine, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec; the
Department of Neurology, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec; and the
Departments of Critical Care Medicine, Medicine, and Community Health Sciences, Faculty of Medicine, The University of Calgary, Calgary, Alberta, Canada.

Address correspondence to: Dr. Leonard Baron, Department of Anesthesia, Misericordia Community Hospital, 16940 – 87 Avenue, Edmonton, Alberta T5R 4H5, Canada. Phone: 780-735-2863; Fax: 780-735-2967; E-mail: lenbaron{at}shaw.ca

Purpose: 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.

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

Principal findings: 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.

Conclusion: 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.

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