A survey of American neurologists about brain death: understanding the conceptual basis and diagnostic tests for brain death

A previously validated survey was mailed to a random sample of 500 board-certified neurologists in the United States. Main outcomes were: responses indicating the concept of death that BD fulfills and the empirical state of the brain that would rule out BD.After the second mailing, 218 (44%) surveys were returned. Few (n = 52, 27%; 95% confidence interval (CI), 21%, 34%) responded that BD is death because the organism has lost integrative unity. The most common justification was a higher brain concept (n = 93, 48%; 95% CI, 41%, 55%), suggesting that irreversible loss of consciousness is death. Contrary to the recent President's Council on Bioethics, few (n = 22, 12%; 95% CI, 8%, 17%) responded that the irreversible lack of vital work of an organism is a concept of death that the BD criterion may satisfy. Many responded that certain brain functions remaining are not compatible with a diagnosis of BD, including EEG activity, evoked potential activity, and hypothalamic neuroendocrine function. Many also responded that brain blood flow and lack of brainstem destruction are not compatible with a diagnosis of BD.American neurologists do not have a consistent rationale for accepting BD as death, nor a clear understanding of diagnostic tests for BD.There are two ways to diagnose death: irreversible loss of circulation, and irreversible loss of all functions of the brain, including the brainstem [1]. Each is a criterion for death, because it marks the univocal state of death, the irreversible loss of the function of the organism as a whole. Integrative unity of the organism, including resistance of entropy and maintenance of internal homeostasis, is lost, leaving a mere collection of tissues and organs [1-4]. For medicine, law, and ethics, this is the written standard rationale for accepting brain death (BD) as a criterion for death [1-4]. The tests used at the bedside to diagnose BD verify the irreversible loss of all functions of the brain. Neurologists in the intensive ca