Concept of ‘brain death’
Definition
- Death determined by neurological criteria - a legal and clinical determination of death, not of a state of severe injury
- *The patient is dead. Ventilation and circulation continue mechanically; the person does not*
- Australian and New Zealand (ANZICS) definition: irreversible cessation of ALL function of the WHOLE brain, INCLUDING the brainstem
- *Contrast the United Kingdom, which uses a BRAINSTEM-only formulation of death*
- Clinical testing in both jurisdictions nonetheless rests on demonstrating absent brainstem reflexes and apnoea - the difference is conceptual, and it is what the exam asks
- Australian law defines death as either:
1. Irreversible cessation of all function of the brain, OR
2. Irreversible cessation of circulation of blood in the body
- Distinguish from
- Coma - unarousable unresponsiveness, brainstem function present
- Persistent vegetative state - wakefulness without awareness; brainstem intact, sleep-wake cycles present. NOT death
- Minimally conscious state - inconsistent but reproducible purposeful behaviour
- Locked-in syndrome - ventral pontine lesion; fully aware, quadriplegic and anarthric, communicating by vertical eye movement and blinking. NOT death, and catastrophic to mistake
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