Editing Brain death (section)

==Medicolegal history==

Brain death is a medicolegal death of a person due to the complete and irreversible loss of all brain functions, including the brain stem. The definition of brain death is accepted in numerous regions, it is one of the most complicated topics in medical ethics today. In [[operational definition]]s of death have obvious medicolegal implications (in [[medical jurisprudence]] and [[medical law]]). Traditionally, both the legal and medical communities determined [[death]] through the permanent end of certain [[Human body|bodily]] functions in [[clinical death]], especially [[Respiration (physiology)|respiration]] and [[Cardiac cycle|heartbeat]]. With the increasing ability of the medical community to [[resuscitate]] people with no respiration, heartbeat, or other external signs of life, the need for another definition of death occurred, raising questions of [[legal death]]. This gained greater urgency with the widespread use of [[life support]] equipment and the rising capabilities and demand for [[organ transplantation]].

Since the 1960s, laws governing the determination of death have been implemented in all countries that have active organ transplantation programs. The first European country to adopt brain death as a legal definition (or indicator) of death was [[Finland]] in 1971, while in the [[United States]], the state of [[Kansas]] had enacted a similar law earlier.<ref name=":1">{{cite journal | author=(Randell T. | title=Medical and legal considerations of brain death | journal=Acta Anaesthesiologica Scandinavica | volume=48 | issue=2 | year=2004 | pages=139–44 | pmid=14995934 | doi=10.1111/j.0001-5172.2004.00304.x| s2cid=38019096 }}</ref>

An ''[[ad hoc]]'' committee at [[Harvard Medical School]] published a pivotal 1968 report to define irreversible [[coma]].<ref>{{cite journal | year = 1968 | title = A definition of irreversible coma: report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death | journal = JAMA | volume = 205 | issue = 6| pages = 337–40 | doi=10.1001/jama.1968.03140320031009| pmid = 5694976 }}</ref><ref>{{cite book|url=https://books.google.com/books?id=rAz4nl35KkIC&pg=PA59|title=Life-sustaining technologies and the elderly.|publisher=Diane Publishing|via=Google Books|isbn=978-1-4289-2281-5|year=1987}}</ref> The Harvard criteria gradually gained consensus toward what is now known as brain death. In the wake of the 1976 [[Karen Ann Quinlan case]], state legislatures in the United States moved to accept brain death as an acceptable indication of death. In 1981, a [[Presidential Commission (United States)|presidential commission]] issued a landmark report entitled ''Defining Death: Medical, Legal, and Ethical Issues in the Determination of Death'',<ref>{{cite book |title=Defining death: a report on the medical, legal and ethical issues in the determination of death |publisher=President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research |hdl=1805/707 |hdl-access=free |date=July 1981}}</ref> which rejected the "higher-brain" approach to death in favor of a "whole-brain" definition. This report formed the basis for the [[Uniform Determination of Death Act]], since enacted in 39 states.<ref>{{cite web|title=Legislative Fact Sheet – Determination of Death Act|url=http://uniformlaws.org/LegislativeFactSheet.aspx?title=Determination%20of%20Death%20Act|archive-url=https://web.archive.org/web/20120201163046/http://uniformlaws.org/LegislativeFactSheet.aspx?title=Determination%20of%20Death%20Act|url-status=dead|archive-date=1 February 2012|publisher=Uniform Law Commission|access-date=8 May 2012}}</ref> Today, both the legal and medical communities in the US use "brain death" as a legal definition of death, allowing a person to be declared [[legal death|legally dead]] even if life support equipment maintains the body's [[metabolic process]]es.<ref>{{cite web| url=http://pntb.org/wordpress/wp-content/uploads/Uniform-Determination-of-Death-1980_5c.pdf| title=Uniform Determination of Death Act| publisher=National Conference of Commissioners on Uniform State Laws| access-date=26 March 2014| archive-url=https://web.archive.org/web/20160304131421/http://pntb.org/wordpress/wp-content/uploads/Uniform-Determination-of-Death-1980_5c.pdf| archive-date=4 March 2016}}</ref>

In the UK, the [[Royal College of Physicians]] reported in 1995, abandoning the 1979 claim that the tests published in 1976 sufficed for the diagnosis of brain death, and suggesting a new definition of death based on the irreversible loss of brain-stem function alone.<ref>{{cite journal |title=Criteria for the diagnosis of brain stem death. Review by a working group convened by the Royal College of Physicians and endorsed by the Conference of Medical Royal Colleges and their Faculties in the United Kingdom |journal=J R Coll Physicians Lond |volume=29 |issue=5 |pages=381–82 |date=1995 |pmid=8847677 |pmc=5401215 }}</ref> This new definition, the irreversible loss of the capacity for consciousness and for spontaneous breathing, and the essentially unchanged 1976 tests held to establish that state, have been adopted as a basis of death certification for organ transplant purposes in subsequent Codes of Practice.<ref>"A Code of Practice for the Diagnosis and Confirmation of Death." Academy of Medical Royal Colleges, London, 2008</ref><ref>American Academy of Neurology. (2000, January 13).Spontaneous Movements Often Occur After Brain Death. Science Daily.</ref> The Australia and New Zealand Intensive Care Society (ANZICS) states that the "determination of brain death requires that there is unresponsive coma, the absence of brain-stem reflexes and the absence of respiratory centre function, in the clinical setting in which these findings are irreversible. In particular, there must be definite clinical or [[Neuroimaging|neuro-imaging]] evidence of acute brain pathology (e.g. traumatic brain injury, intracranial haemorrhage, hypoxic encephalopathy) consistent with the irreversible loss of neurological function."<ref>{{cite book|url=http://www.anzics.com.au/Downloads/ANZICS%20Statement%20on%20%20Death%20and%20Organ%20Donation%20Edition%203.2.pdf|title=The ANZICS Statement on Death and Organ Donation|publisher=Australian and New Zealand Intensive Care Society|edition=3.2|location=Melbourne|year=2013|page=17|isbn=978-1-876980-21-4|archive-url=https://web.archive.org/web/20180319202056/http://www.anzics.com.au/Downloads/ANZICS%20Statement%20on%20%20Death%20and%20Organ%20Donation%20Edition%203.2.pdf|archive-date=March 19, 2018}}</ref>  In Brazil, the Federal Council of Medicine revised its regulations in 2017, including "a requirement for the patient to meet specific physiological prerequisites and for the physician to provide optimized care to the patient before starting the procedures for diagnosing brain death and to perform complementary tests, as well as the need for specific training for physicians who make this diagnosis."<ref>{{Cite journal|last1=Westphal|first1=Glauco Adrieno|last2=Veiga|first2=Viviane Cordeiro|last3=Franke|first3=Cristiano Augusto|date=July–September 2019|title=Diagnosis of brain death in Brazil|journal=Revista Brasileira de terapia intensiva.|volume=31|issue=3|pages=403–09|doi=10.5935/0103-507X.20190050|pmc=7005965|pmid=31618361}}</ref>

In 2020, an international panel of experts, the World Brain Death Project, published a [[medical guideline|guideline]] that:<ref name="pmid-32761206">{{cite journal |last1=Greer |first1=DM |last2=Shemie |first2=SD |last3=Lewis |first3=A |last4=Torrance |first4=S |last5=Varelas |first5=P |last6=Goldenberg |first6=FD |display-authors=et al |title=Determination of Brain Death/Death by Neurologic Criteria: The World Brain Death Project. |journal=JAMA |date=15 September 2020 |volume=324 |issue=11 |pages=1078–97 |doi=10.1001/jama.2020.11586 |pmid=32761206|s2cid=221038198 }}</ref><blockquote>provides recommendations for the minimum clinical standards for determination of brain death/death by neurologic criteria (BD/DNC) in adults and children with clear guidance for various clinical circumstances. The recommendations have widespread international society endorsement and can serve to guide professional societies and countries in the revision or development of protocols and procedures for determination of brain death/death by neurologic criteria, leading to greater consistency within and between countries. 

The World Brain Death Project, published in 2020 by Greer et al., provides some of the most comprehensive and globally recognized recommendations for determining brain death. Their *JAMA* The agreement statement offers detailed evidence in protocols for diagnosing brain death in adults and children. It focuses on a standard clinical process, additional testing when necessary, and special considerations in difficult cases. One of the project's main goals is to reduce variability in brain death diagnosis by creating a consistent, internationally framework (Greer et al., 2020). </blockquote>