Robert D. Truog
Over the past several decades, the concept of brain death has become well entrenched within the practice of medicine. At a practical level, this concept has been successful in delineating widely accepted ethical and legal boundaries for the procurement of vital organs for transplantation. Despite this success, however, there have been persistent concerns over whether the concept is theoretically coherent and internally consistent. 1 Indeed, some have concluded that the concept is fundamentally flawed, and that it represents only a "superficial and fragile consensus." 2 In this analysis I will identify the sources of these inconsistencies, and suggest that the best resolution to these issues may be to abandon the concept of brain death altogether.
In its seminal work "Defining Death," the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research articulated a formulation of brain death that has come to be known as the "whole-brain standard." 3 In the Uniform Determination of Death Act, the President's Commission specified two criteria for determining death: (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brainstem."
Neurologist James Bernat has been influential in defending and refining this standard. Along with others, he has recognized that analysis of the con-____________________