Semin Neurol 2015; 35(02): 162-168
DOI: 10.1055/s-0035-1547538
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Uniformity in Brain Death Criteria

Sam D. Shemie
1   Division of Critical Care, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
2   Medical Advisor, Canadian Blood Services
Andrew Baker
3   Department of Critical Care and Anesthesia, St. Michael's Hospital, Toronto, Ontario, Canada
› Author Affiliations
Further Information

Publication History

Publication Date:
03 April 2015 (online)


Despite well-described international variabilities in brain death practices, de facto there already exists a minimum international clinical standard for the diagnosis of brain death. This remains rooted in the Harvard criteria and based on the characteristics of a permanently nonfunctioning brain. Medicine is evolving toward a single unified determination of death based on the cessation of brain function subsequent to catastrophic brain injury or circulatory arrest. Clarity in lexicon could be established, including movement toward functional definitions and away from anatomically based terms such as cardiac and brain death that erroneously imply death of the organ. The cessation of clinical functions of the brain that will not resume is determined by the absence of capacity for consciousness, centrally mediated motor responses, brainstem reflexes, and capacity to breathe. A known proximate cause and the absence of confounding or reversible conditions must be confirmed. Regional medical, legal, cultural, religious, or socioeconomic factors may require testing beyond this minimal clinical standard.