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Article
October 2, 1972

Death Criteria

JAMA. 1972;222(1):86. doi:10.1001/jama.1972.03210010066018

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Abstract

To the Editor.—  The Harvard Committee Criteria for the determination of cerebral death (221:48, 1972) lead me to this comment on unnecessary conservatism. These include total unresponsiveness and absence of all reflexes. As a neurosurgeon, I have had the opportunity to observe many patients in the cerebral death condition, usually secondary to craniocerebral trauma or massive intracranial hemorrhage. Actually, it is not infrequent to find active spinal reflexes present, particularly in children, and it is becoming more evident and easily elicitable as time progresses. These reflexes include a peculiar slow flexor plantar response that may be mistaken for a negative Babinski reflex, and frequently, brisk withdrawal of the lower limbs with painful stimuli. The movements and reflexes are similar to those seen in experimental animal preparations involving high cervical cord transection and probably represent spinal cord reflex activity released from cerebral and brain stem inhibition, as a result of total

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