The definition of death by neurologic criteria (DNC), commonly referred to as brain death, has not changed significantly since the 1960s, but the validity of this definition has been frequently challenged from ethical, philosophical, and religious standpoints. Multidisciplinary committees of experts have convened to update guidelines and redefine criteria for DNC, but despite efforts to standardize the criteria, significant variation remains. We will explore the historical development of brain death as a concept, the development of criteria in DNC, changing guidelines and implementation challenges, and the ethical and legal controversies that often arise in discussing brain death with families. We will also discuss public perception of brain death which can create tension between medical teams and families struggling with acceptance of DNC, and the idea of reasonable accommodations, such as additional time to accept DNC determination after the diagnosis is made before discontinuation of organ support. This highlights the importance of trauma-informed care and shared decision making in cases of pediatric DNC.
Chang et al. (Fri,) studied this question.