Guidelines propose new way to define ‘death’

Until now, medical practice distinguished between two forms of death: brain and cardiac. But new clinical practice guidelines published in a special issue of the Canadian Journal of Anesthesia, present a unique, brain-based definition of death. According to these guidelines, “death is defined as the permanent cessation of brain function (i.e. brain function is lost, will not resume spontaneously and will not be restored by intervention) and is characterized by the complete absence of any form of consciousness (wakefulness and awareness) and the absence of brainstem reflexes, including the ability to breathe independently.” Read: Thought chocolate: Flavanols from cocoa help age-related memory loss They also state that “residual brain cell activity that is not associated with the presence of consciousness or brainstem function does not preclude the recognition of death. For example, the release of antidiuretic hormone of the posterior pituitary, temperature control or neuronal activity at the cellular level.” On the other hand, death must not be declared by a doctor “if there remains a level of consciousness and/or a residual function of the brainstem, whatever its reduction.” “What you have to understand is that cardiac death is actually equivalent to brain death, since the cessation of circulation interrupts cerebral blood flow, which leads to the rapid loss of brain function,” says Dr. Sam Shemie, who led the development of the new guidelines. “At the end of the day, it all boils down to one simple truth: the only organ that cannot be artificially maintained or replaced is the brain. When the brain stops working completely, the person is dead.” Shemi is a specialist in pediatric intensive care medicine at the Montreal Children's Hospital of the McGill University Health Center (MUHC) and also an associate researcher of the Research Program in Lifelong Cardiovascular Health from the Research Institute of the MUHC. Read: The abbreviated life of Lane Mandlis Beyond providing a harmonized definition of death, these guidelines also present updated criteria for determining death in the event of devastating brain injury or circulatory arrest. Criteria that replace previous Canadian recommendations and “are essential to ensure the legal and ethical practice of organ donation from a deceased person,” says the MUHC press release announcing the new guidelines. Entitled A brain-based definition of death and criteria for its determination after arrest of circulation or neurologic function in Canada, these guidelines are the result of work, funded in part by Health Canada, that was conducted in partnership with the Canadian Critical Care Society, Canadian Blood Services and the Canadian Medical Association. Nurses, radiologists, neurologists, anesthesiologists, ethicists, lawyers, families of patients and public partners from across Canada contributed. The guidelines have been endorsed by the Canadian Medical Association, Canadian Critical Care Society, Canadian Blood Services, Canadian Neurological Sciences Federation, Canadian Association of Emergency Physicians, Canadian Anesthesiologists' Society, Canadian Association of Critical Care Nurses, the Nurse Practitioners Association of Canada, the Health Canada Organ Donation and Transplantation Collaborative, the Donation and Transplantation Research Program of Canada and the Canadian Society for Cardiovascular Critical Care. This article has been translated from its original French and first appeared on our sister site Profession Santé.

Guidelines propose new way to define ‘death’

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