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July 22 2009

Controversies About Brain Death

JAMA. 2009;302(4):380-382. doi:10.1001/jama.2009.1038

To the Editor: The review by Dr Rosenberg1 of the JAMA Classics article on the definition of brain death contains a number of sentences that I find unclear. He states, “Coma refers to the clinical state in which a patient is unarousable and does not respond to stimuli.” In both coma and persistent vegetative state (PVS), the patient is unarousable, and in both there is usually reflex response to some stimuli. It is the presence of periods of wakefulness that distinguishes the 2 syndromes. He also states that “a meaningful and functional return to consciousness occurs with regularity from PVS. . . . ” However, the Multi-Society Task Force reported that at 1 year only 7% of patients with traumatic causes and 1% of patients with nontraumatic causes of PVS had good recovery.2

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