Brain death: Criteria, signs, and tests

Objective: This paper identified ethical issues relating to brain death and analyzed them according to the purposes of the Law, maqasid al shari'at, and principles of the law, qawa'id al fiqh, to reach conclusions of practical importance. Methods: Issues arising in brain death were selected from articles retrieved from PUBMED over a 10-year period. Practical and conceptual issues identified in the articles were analyzed using maqasid al shari'atand qawa'id al fiqh. Results: Early determination of death by use of brain death criteria was motivated by the need to harvest transplantation organs earlier, to save intensive care resources by earlier cessation of life support, and to obtain tissues for research before deterioration. These motives would violate the principle of intention which requires that actions be judged by underlying intentions and that the end does not justify the means. In this case the nobility of the ends and their public interest were overriding considerations. The requirements, by the principle of certainty, of evidence-based proof of death were partially fulfilled by brain death criteria, tests, and examinations. The principle of custom was partially fulfilled because there was no universal consensus on criteria of brain death; the criteria varied by country, by institution, and over time. Conclusions and recommendations: Brain stem death, determined by clinical examination with or without instrumental confirmation, should remain the mainstay of death definition. Legal rulings on brain death should be reviewed every 3 years to take into consideration new developments in medical knowledge and technology. (C) 2013 Taibah University. Production and hosting by Elsevier Ltd. All rights reserved.