Abstract

Complexities and misunderstanding related to the determination of death continue to evolve in response to remarkable technological advances in the ability to support, replace or transplant failing organs. This paper reviews the principles of management of life-threatening critical illness and the corresponding biological aspects of life, death and organ donation which are both informed and complicated by these technological and scientific achievements. Clarity in lexicon should be established, including movement toward functional definitions and away from anatomically based terms such as cardiac and brain death that erroneously imply death of the organ. Medicine is evolving towards a single unified determination of death, based on the cessation of brain function subsequent to catastrophic brain injury or circulatory arrest. In the presence of clear cause and in the absence of reversible or confounding conditions, the cessation of clinical functions of the brain that will not resume is determined by the absence of capacity for consciousness, centrally mediated motor responses, brainstem reflexes and capacity to breathe.