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

Annals of Intensive Care

Table 3 Response to the question about what, in the respondent's own words, makes a patient dead

Concept given to justify why brain death is death	Neurologist responses (n = 192) [n (%; 95% confidence interval)]	Neurologists who agreed the conceptual basis makes brain death equivalent to death (n = 133) [n (%; 95% confidence interval)]
Higher brain concept	63 (33%; 27-40%)	52 (39%; 31-48%)
Loss of integration of body concept	15 (8%; 5-13%)	13 (10%; 6-16%)
Loss of integration alone	7 (4%; 2-7%)	7 (5%; 2-11%)
Loss of integration combined with higher brain concept	8 (4%; 2-8%)	6 (5%; 2-10%)
Prognosis concept	9 (5%; 2-9%)	5 (4%; 1-9%)
Prognosis of death certain	7 (4%; 2-7%)	3 (2%; 1-7%)
Quality of life statement	2 (1%; 0-4%)	2 (2%; 0-6%)
No concept given	96 (50%; 43-57%)	59 (44%; 36-53%)
Re-statement only: loss of brain function (the criterion)	32 (17%; 12-23%)	23 (17%; 12-25%)
No response (blank)	64 (33%; 27-40%)	36 (27%; 20-35%)
Vital work of organism concept^a	4 (2%; 1-5%)	0 (0%; 0-2%)
Other	9 (5%; 2-9%)	4 (3%; 1-8%)

The exact question was as follows: "This patient fulfills all brain death criteria unequivocally including the suitable interval. Conceptually, why are they dead (i.e., in your own words, what is it about loss of brain function including the brainstem that makes this patient dead)?" The standard medical, ethical, and legal conceptual reason is (as defined by the President's Commission and neurologist groups): the irreversible loss of the integration of body functions by the brain [1–4, 10, 11].
^aResponses were: "cannot independently sustain itself"; "irreversible loss of interaction with the environment and no ability to function"; "no longer capable of any activity that leads to self preservation"; and "the organism is no longer capable of interacting with the environment internally or externally."