In Reply: Drs de Groot and Kompanje identify important ongoing issues regarding the declaration of death and DCD. However, they fail to acknowledge ongoing criticism of current neurological criteria of death, insufficiently characterize the duration of ischemia needed for irreversible cessation of all functions of the entire brain, and hold DCD to a higher standard of irreversibility than is used in other clinical contexts.
In their letter, de Groot and Kompanje focus on loss of brain function as the fundamental criterion of death. There has been, however, substantial criticism of this approach. Critics argue that individuals fulfilling neurological criteria may retain integrative function of the posterior pituitary and do not inevitably progress to cardiac arrest quickly.1 Thus, the premise stated by de Groot and Kompanje may be equally problematic as what they criticize.
Antommaria AHM, Frader J. Policies of Children’s Hospitals on Donation After Cardiac Death—Reply. JAMA. 2009;302(8):844-845. doi:10.1001/jama.2009.1208