Debating the criteria for brain death

The article on the bioethics of brain death by Neil Lazar and colleagues does a superb job of covering the basic issues.¹ However, one important situation that the authors do not discuss concerns the patient with a massive head injury who meets the criteria for brain death imperfectly, perhaps because a small patch of neurons in a brain-stem nucleus are still operating. In real-world clinical practice such patients have zero chance of survival and so are withdrawn from life support, their organs going to waste.

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D. John Doyle
Department of Anesthesia University of Toronto Toronto, Ont.