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New perspectives on brain death
  1. Matthew P. Kirschen1,
  2. Ariane Lewis2,
  3. Michael Rubin3,
  4. Pedro Kurtz4,
  5. David M Greer5
  1. 1 Anesthesia and Critical Care Medicine, Neurology and Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
  2. 2 Neurology and Neurosurgery, NYU Langone Medical Center, New York, New York, USA
  3. 3 Neurology, University of Texas Southwestern Medical School, Dallas, Texas, USA
  4. 4 Hospital Copa Star, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil
  5. 5 Neurology, Boston University, Boston, Massachusetts, USA
  1. Correspondence to Dr David M Greer, Neurology, Boston University, Boston, MA 02215, USA; dgreer{at}


Brain death, or death by neurological criteria (BD/DNC), has been accepted conceptually, medically and legally for decades. Nevertheless, some areas remain controversial or understudied, pointing to a need for focused research to advance the field. Multiple recent contributions have increased our understanding of BD/DNC, solidified our practice and provided guidance where previously lacking. There have also been important developments on a global scale, including in low-to-middle income countries such as in South America. Although variability in protocols and practice still exists, new efforts are underway to reduce inconsistencies and better train practitioners in accurate and sound BD/DNC determination. Various legal challenges have required formal responses from national societies, and the American Academy of Neurology has filled this void with much needed guidance. Questions remain regarding concepts such as ‘whole brain’ versus ‘brainstem’ death, and the intersection of BD/DNC and rubrics of medical futility. These concepts are the subject of this review.

  • acquired brain injury
  • traumatic brain injury

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  • Contributors DMG planned and provided oversight for the work, and was primary author for the sections on brainstem death and training and certification. DMG is the overall guarantor of the overall content. MK took the lead on revisions, and was the primary author for the Introduction and Pediatrics sections. AL took the lead on the sections on Legal Efforts and the World Brain Death Project. MR took the lead on the section on ethical issues. PK took the lead on the section on International/Brazil perspective.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.