With the advent of cardiopulmonary resuscitation techniques, the cardiopulmonary definition of death lost its significance in favor of brain death. Brain death is a permanent cessation of all functions of the brain in which though individual organs may function but lack of integrating function of the brain, lack of respiratory drive, consciousness, and cognition confirms to the definition that death is an irreversible cessation of functioning of the organism as a whole. In spite of medical and legal acceptance globally, the concept of brain death and brain-stem death is still unclear to many. Brain death is not promptly declared due to lack of awareness and doubts about the legal procedure of certification. Many brain dead patients are kept on life supporting systems needlessly. In this comprehensive review, an attempt has been made to highlight the history and concept of brain death and brain-stem death; the anatomical and physiological basis of brain-stem death, and criteria to diagnose brain-stem death in India.
Wijdicks EF. Brain Death. Philadelphia: Lippincott Williams and Wilkins; 2001. p. 175.
Wig N, Gupta P, Kailash S. Awareness of brain death and organ transplantation among select Indian population. J Assoc Physicians India 2003;51:455-8.
Bapat U, Kedlaya PG, Gokulnath. Organ donation, awareness, attitudes and beliefs among post graduate medical students. Saudi J Kidney Dis Transpl 2010;21:174-80.
Shroff S, Navin S, Abraham G, Rajan PS, Suresh S, Rao S, et al. ′Ramachandra protocol′ for organ donation. Antiseptic 1997;94:73-4.
Government of India. Ministry of Law, Justice and Company Affairs (Legislative Department) New Delhi. The Transplantation of Human Organs Act, 1994. Central Act 42 of 1994. Available from: http://www.health.bih.nic.in/Rules/THOA-1994.pdf. [Last accessed on 2014 Jul 11].
Government of India. Ministry of Law, Justice and Company Affairs (Legislative Department) New Delhi. The Transplantation of Human Organs (Amendment) Act, 2011. (No. 16 of 2011) Available from: http://www.mohanfoundation.org/THO-amendment-act-2011.pdf. [Last accessed on 2014 Jul 11].
Government of Maharashtra, Public Health Department, Government Resolution No. MAP2012/C.R.289/AROGYA-6. Mumbai: Mantralaya. [2012 Sep 13]. Available from: https://www.maharashtra.gov.in/Site/Upload/Government%20Resolutions/English/201209141533080800.pdf;/201209141531450800.pdf;/201209141533590800.pdf. [Last accessed on 2014 Jul 11].
Reddy KS. In: The Essentials of Forensic Medicine and Toxicology. 27 th ed., Ch. 6. 2008. p. 119.
Horsley V. On the mode of death in cerebral compression and its prevention. Q Med J 1894;2:306-9.
Duckworth D. Some cases of cerebral disease in which the function of respiration entirely ceases for some hours before that of the circulation. Edinb Med J 1898;3:145-52.
Cushing H. Some experimental and clinical observations concerning states of increased intracranial tension. Am J Med Sci 1902;124:375-400.
Crafoord C. Do¨dsorsaken vid obturerande lungemboli [The cause of death by obstructing pulmonary embolism]. Nord Med 1939;2:1043-4.
Hill L. On cerebral anaemia and the effects which follow ligation of the cerebral arteries. Philos Trans 1900;39:69-122.
Wertheimer P, Jouvet M, Descotes J. Diagnosis of death of the nervous system in comas with respiratory arrest treated by artificial respiration. Presse Med 1959;67:87-8.
mollaret P, Goulon M. The depassed coma (preliminary memoir). Rev Neurol (Paris). 1959;101:3-15.
Powner DJ, Ackerman BM, Grenvik A. Medical diagnosis of death in adults: Historical contributions to current controversies. Lancet 1996;348:1219-23.
Schwab RS, Potts F, Bonazzi A. EEG as an aid in determining death in the presence of cardiac activity ethical, legal, and medical aspects. Electroencephalogr Clin Neurophysiol 1963;15:147-8.
A definition of irreversible coma. Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death. JAMA 1968;205:337-40.
Wijdicks EF. Brain death worldwide: Accepted fact but no global consensus in diagnostic criteria. Neurology 2002;58:20-5.
Mohandas A, Chou SN. Brain death. A clinical and pathological study. J Neurosurg 1971;35:211-8.
Diagnosis of brain death. Statement issued by the honorary secretary of the conference of medical royal colleges and their Faculties in the united Kingdom on 11 October 1976. Br Med J 1976;2:1187-8.
Diagnosis of death. Memorandum issued by the honorary secretary of the conference of medical royal colleges and their faculties in the UK. Lancet 1979;313:261-2.
A code of practice for the diagnosis of brain stem death. Working Party Established through the Royal College of Physicians on Behalf of the Academy of Medical Royal Colleges at the Request of the Health Departments, March 1998. Available from: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4035462.pdf. [Last accessed on 2014 Jul 11].
A Code of Practice for the Diagnosis and Confirmation of Death. London: Academy of Medical Royal Colleges; 2008. Available from: http://www.aomrc.org.uk/doc_view/42-a-code-of-practice-for-the-diagnosis- and-confirmation-of-death. [Last accessed on 2014 Jul 11].
Youngner SJ, Arnold RM, Schapiro R. The Definition of Death: Contemporary Controversies. Baltimore: Johns Hopkins University Press; 1999. p. 1-348.
Pallis C, Harley DH. ABC of Brainstem Death. 2 nd ed. London: BMJ Publishing Group; 1996. p. 8-12.
President′s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Defining Death: Medical, Legal and Ethical Issues in the Determination of Death. Washington, D.C.: Government Printing Office; 1981. Available from: http://www.euthanasia.procon.org/sourcefiles/PresCommDefiningDeath.pdf. [Last accessed on 2014 Jul 11].
Uniform Determination of Death Act. Available from: http://www.lchc.ucsd.edu/cogn_150/Readings/death_act.pdf. [Last accessed on 2014 Jul 11].
Law Reform Commission of Canada, Criteria for the Determination of Death, Ottawa: Law Reform Commission of Canada; 1981. Available from: http://www.lareau-law.ca/LRCReport15.pdf. [Last accessed on 2014 Jul 11].
Death and brain death: A new formulation for Canadian medicine. Canadian Congress Committee on Brain Death. CMAJ 1988;138:405-6.
Practice parameters for determining brain death in adults (summary statement). The Quality Standards Subcommittee of the American Academy of Neurology. Neurology 1995;45:1012-4.
The President′s Council on Bioethics. Controversies in the determination of death: A white paper of the President′s Council on Bioethics 2008. Washington, DC, 2008. Available from: http://www.bioethics.georgetown.edu/pcbe/reports/death/Controversies% 20in% 20the%20Determination%20of%20Death%20for%20the%20Web%20%282%29.pdf. [Last accessed on 2014 July 11].
Shewmon DA. Brain death: Can it be resuscitated? Hastings Center Report, March-April 2009. p. 18-24.
Smith M. Brain death: Time for an international consensus. Br J Anaesth 2012;108 Suppl 1:i6-9.
Wijdicks EF, Varelas PN, Gronseth GS, Greer DM, American Academy of Neurology. Evidence-based guideline update: Determining brain death in adults: Report of the quality standards subcommittee of the American academy of neurology. Neurology 2010;74:1911-8.
Webb AC, Samuels OB. Reversible brain death after cardiopulmonary arrest and induced hypothermia. Crit Care Med 2011;39:1538-42.
Wijdicks EF, Varelas PN, Gronseth GS, Greer DM. There is no reversible brain death. Crit Care Med 2011;39:2204-5.
Webb A, Samuels OB. There is no reversible brain death. Crit Care Med 2011;39:2206.
Nakagawa TA, Ashwal S, Mathur M, Mysore M, Society of Critical Care Medicine, Section on Critical Care and Section on Neurology of American Academy of Pediatrics, Child Neurology Society. Clinical report-Guidelines for the determination of brain death in infants and children: An update of the 1987 task force recommendations. Pediatrics 2011;128:e720-40.
Capron AM. Brain death: Well settled yet still unresolved. N Engl J Med 2001;344:1244-6.
The Definition of Death. Stanford Encyclopedia of Philosophy. First Published, [2007 Oct 26, Fri]; Substantive Revision, [2011 Aug 25, Thu]. Available from: http://www.plato.stanford.edu/entries/death-definition/. [Last accessed on 2014 Jul 11].
Bernat JL. Ethical Issues in Neurology. 2 nd ed. Boston: Butterworth Heinemann; 2002. p. 243-81.
Becker LC. Human being: The boundaries of the concept. Philos Public Aff 1975;4:334-59.
Bernat JL, Culver CM, Gert B. On the definition and criterion of death. Ann Intern Med 1981;94:389-94.
Shewmon DA. Recovery from "brain death": A neurologist′s apologia. Linacre Q 1997;64:30-96.
Grigg MM, Kelly MA, Celesia GG, Ghobrial MW, Ross ER. Electroencephalographic activity after brain death. Arch Neurol 1987;44:948-54.
Powner DJ, Hendrich A, Lagler RG, Ng RH, Madden RL. Hormonal changes in brain dead patients. Crit Care Med 1990;18:702-8.
Veatch RM. The impending collapse of the whole-brain definition of death. Hastings Cent Rep 1993;23:18-24.
Potts M. A requiem for whole brain death: A response to D. Alan Shewmon′s ′the brain and somatic integration′. J Med Philos 2001;26:479-91.
Shewmon AD. The brain and somatic integration: Insights into the standard biological rationale for equating "brain death" with death. J Med Philos 2001;26:457-78.
Bernat JL. A defense of the whole-brain concept of death. Hastings Cent Rep 1998;28:14-23.
Bernat JL. The whole-brain concept of death remains optimum public policy. J Law Med Ethics 2006;34:35-43, 3.
Wijdicks EF. Brain Death. Philadelphia: Lippincott Williams and Wilkins; 2000. p. 29-43.
Brody BA. How much of the brain must be dead? In: Youngner SJ, Arnold RM, Schapiro R, editors. The Definition of Death: Contemporary Controversies. Baltimore: The Johns Hopkins University Press; 1999. p. 73.
Shewmon DA. "Brainstem death," "brain death" and death: A critical re-evaluation of the purported equivalence. Issues Law Med 1998;14:125-45.
Bernat JL. Philosophical and ethical aspects of brain death. In: Wijdicks EF, editor. Brain Death. Philadelphia: Lippincott Williams and Wilkins; 2001. p. 171-87.
Veatch RM. Death, Dying, and the Biological Revolution: Our Last Quest for Responsibility. New Haven, Conn: Yale University Press; 1976.
Bernat JL. Ethical issues in the perioperative management of neurologic patients. Neurol Clin 2004;22:viii-ix, 457.
Government of India. Ministry of Law, Justice and Company Affairs (Legislative Department) New Delhi. The Transplantation of Human Organs Rules, 1995 (GSR NO. 51(E), dr. [1995 Feb 04]). [As amended vide GSR 571(E), dt. 2008 Jul 31].
Government of India. Ministry of Law, Justice and Company Affairs (Legislative Department) New Delhi. Transplantation of Human Organs (Amendment) Rules, 2008. Available from: http://www.health.bih.nic.in/Rules/THO-A-Rules-2008.pdf. [Last accessed on 2014 July 11].
Snell RS. In: Clinical Neuroanatomy. 7 th ed. New Delhi, Philadelphia: Wolters Kluwer/Lippincott Williams and Wilkins; 2010. p. 196, 297-8, 305-12.
Posner JB, Saper CB, Schiff ND, Plum F. In: Plum and Posner′s Diagnosis of Stupor and Coma. 4 th ed. New York: Oxford University press; 2007.
Saposnik G, Bueri JA, Mauriño J, Saizar R, Garretto NS. Spontaneous and reflex movements in brain death. Neurology 2000;54:221-3.
Wijdicks EF, Rabinstein AA, Manno EM, Atkinson JD. Pronouncing brain death: Contemporary practice and safety of the apnea test. Neurology 2008;71:1240-4.
Sutcliffe AJ. Current issues in the diagnosis of brain stem death. Indian J Crit Care Med 2004;8:185-9.
Wijdicks EF, Pfeifer EA. Neuropathology of brain death in the modern transplant era. Neurology 2008;70:1234-7.
Powner DJ, Hernandez M, Rives TE. Variability among hospital policies for determining brain death in adults. Crit Care Med 2004;32:1284-8.
Greer DM, Varelas PN, Haque S, Wijdicks EF. Variability of brain death determination guidelines in leading US neurologic institutions. Neurology 2008;70:284-9.
Baron L, Shemie SD, Teitelbaum J, Doig CJ. Brief review: History, concept and controversies in the neurological determination of death. Can J Anaesth 2006;53:602-8.
Report of special Task Force. Guidelines for the determination of brain death in children. American Academy of Pediatrics Task Force on Brain Death in Children. Pediatrics 1987;80:298-300.
Danzl DF, Pozos RS. Accidental hypothermia. N Engl J Med 1994;331:1756-60.
Guidelines for the diagnosis of brain death. Canadian Neurocritical Care Group. Can J Neurol Sci 1999;26:64-6.
Wijdicks EF. In search of a safe apnea test in brain death: Is the procedure really more dangerous than we think? Arch Neurol 1995;52:338-9.
Wijdicks EF. The diagnosis of brain death. N Engl J Med 2001;344:1215-21.
Wijdicks EF 10 questions about the clinical determination of brain death. Neurologist 2007;13:380-1.
Goudreau JL, Wijdicks EF, Emery SF. Complications during apnea testing in the determination of brain death: Predisposing factors. Neurology 2000;55:1045-8.
Saposnik G, Rizzo G, Vega A, Sabbatiello R, Deluca JL. Problems associated with the apnea test in the diagnosis of brain death. Neurol India 2004;52:342-5.
Brandstetter RD, Choi MY, Mallepalli VN, Klass S. An unusual cause of pulmonary barotrauma during apneic oxygenation testing. Heart Lung 1994;23:88-9.
Su Y, Yang Q, Liu G, Zhang Y, Ye H, Gao D, et al. Diagnosis of brain death: Confirmatory tests after clinical test. Chin Med J (Engl) 2014;127:1272-7.
Earnest MP, Beresford HR, McIntyre HB. Testing for apnea in suspected brain death: Methods used by 129 clinicians. Neurology 1986;36:542-4.
Young GB, Shemie SD, Doig CJ, Teitelbaum J. Brief review: The role of ancillary tests in the neurological determination of death. Can J Anaesth 2006;53:620-7.
Molina DK, McCutcheon JR, Rulon JJ. Head injuries, pentobarbital, and the determination of death. Am J Forensic Med Pathol 2009;30:75-7.
Ducrocq X, Braun M, Debouverie M, Junges C, Hummer M, Vespignani H. Brain death and transcranial Doppler: Experience in 130 cases of brain dead patients. J Neurol Sci 1998;160:41-6.
de Tourtchaninoff M, Hantson P, Mahieu P, Guérit JM. Brain death diagnosis in misleading conditions. QJM 1999;92:407-14.