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May 1, 2020

Understanding Brain Death

Author Affiliations
  • 1Center for Bioethics, Harvard Medical School, Boston, Massachusetts
  • 2Boston Children’s Hospital, Boston, Massachusetts
  • 3Feinberg School of Medicine, Northwestern University, Chicago, Illinois
  • 4Pediatric Critical Care, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
  • 5Harvard Medical School, Boston, Massachusetts
JAMA. 2020;323(21):2139-2140. doi:10.1001/jama.2020.3593

The concept of brain death, or the determination of death by neurological criteria, was first proposed by a Harvard committee in the United States in 1968,1 and then adopted into the Uniform Determination of Death Act (UDDA) in 1981.2 Although the UDDA was widely accepted and endorsed by medical professional organizations, in recent years the concept has come under greater scrutiny and is increasingly the focus of legal challenges. Most urgent is that the current diagnostic standards do not satisfy the wording of the law. The UDDA defines brain death as the “irreversible cessation of all functions of the entire brain.” Yet, it is now widely acknowledged that some patients who meet the current diagnostic standards may retain brain functions that are not included in the required tests, including hypothalamic functioning.3 Until the UDDA is revised to be more specific about which functions must be lost to satisfy the definition (such as, for example, consciousness and the capacity to breathe), current medical practice will not be in alignment with the legal standard.

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