Author Response: Determination of Death by Neurologic Criteria Around the World

We appreciate Dr. Sethi’s interest in our article.1 We agree that the standards for brain death/death by neurologic criteria (BD/DNC) must be conservative and rigorous to avoid false positive determinations in which patients who have the potential for recovery are declared dead. In addition, a person who is considered dead in one place should not be considered alive elsewhere. The AAN published guidelines on BD/DNC determination with these goals in mind in 1995 and then updated them in 2010.2,3 The 2010 guideline is considered the medically accepted standard for BD/DNC determination in adults in the United States.4 However, as our paper demonstrates, the process of BD/DNC determination varies around the world. This prompted the creation of the World Brain Death Project (WBDP), an international, multidisciplinary collaboration to identify the minimum criteria for BD/DNC. The WBDP is not intended to supplant—or compromise—guidelines from individual countries or medical organizations, such as the AAN. Rather, it will serve as guidance for professional societies and countries to revise or develop guidelines on BD/DNC, with the understanding that each country and medical organization needs to take resources and societal values into consideration when creating guidelines on determination of BD/DNC. This should result in improved consistency in determination of BD/DNC, both within and between countries, and hopefully increase public trust in BD/DNC, thereby increasing—not compromising—the stringency of the process of BD/DNC determination.

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