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August 3, 2020

Standardizing Brain Death Globally

Author Affiliations
  • 1Department of Neurology, University of California, San Francisco, San Francisco
JAMA Neurol. 2020;77(11):1353-1354. doi:10.1001/jamaneurol.2020.1243

Neurologists, neurointensivists, neurosurgeons, and intensivists worldwide at times are required to determine brain death/death by neurological criteria (BD/DNC). Variance in the practice of diagnosis is known to vary by country and region, resulting in the uncomfortable status that a patient is considered deceased in one region but not in another. For example, within the US, a patient can be deceased yet transition to alive simply by crossing a state line.1 Such variations multiply when considering the global scope. To better delineate the range of practice, custom, and legal considerations, more than 50 international medical professionals led a worldwide effort to document global practice to make consensus recommendations for BD/DNC declaration.2 This consensus is summarized in the article,2 which references a 193-page supplement detailing the basis for the recommendations ranging from “recommend” to “it is suggested to” to best deal with the vagaries of international practice. The scope of this review eclipses any prior synopsis on BD/DNC because of its global scope, attention to recent advances in critical care, and summary of how various cultures and religions view the diagnosis. The authors concluded that standard Grading of Recommendations Assessment, Development and Evaluation/Appraisal of Guidelines for Research & Evaluation methods are not applicable given the lack of high-quality randomized studies in the field; therefore, many of the recommendations are based on consensus. Consensus was gained by having a review and endorsement of 5 world federations and 33 medical societies spanning 25 countries and regions and included expertise in adult and pediatric realms. These recommendations apply to the minimal standard for determination of BD/DNC and do not discourage additional practices.

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