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AbstractMuch of the debate over the definition and criteria for determining our death has focused on disagreement over the correct biological account of death, i.e., what it means for any organism to die. In this paper, we argue that this exclusive focus on the biology of death is misguided, because it ignores ethical and social factors that bear on the acceptability of criteria for determining our death. We propose that attention shift from strictly biological considerations to ethical and social considerations that bear on the determination of what we call “civil death.” We argue for acceptance of a neurological criterion for determining death on grounds that it is the most reasonable way to synthesize biological, ethical, and social considerations about our death.. [ABSTRACT FROM AUTHOR]

AbstractEfforts to revise the Uniform Determination of Death Act in order to align law with medical practice have failed. Medical practice must now align with the law. People who are not dead under the law that defines death should not be declared dead. There is no compelling reason to continue the practice of declaring legally living persons to be dead. [ABSTRACT FROM AUTHOR]

The article discusses a study on the Unified Brain-Based Determination of Death conducted by David Rodríguez-Arias and Anne Dalle Ave, published in the journal "American Journal of Bioethics." It examines the challenges surrounding the use of the Unified Brain-Based Determination of Death (UBBDD) in the context of normothermic regional perfusion (NRP) for organ recovery, particularly regarding the interrelationship between circulatory and neurological criteria for death determination.

The article discusses a study on the ethical concerns surrounding NRP (Normothermic Regional Perfusion) conducted by Matthew W. DeCampa and Lois Snyder Sulmasy, published in the journal "The American Journal of Bioethics." It critiques arguments in support of NRP, highlighting five persistent myths propagated by its proponents, emphasizing ethical objections related to the resuscitation of donors and the violation of the dead donor rule.

The introduction of normothermic regional perfusion (NRP) in controlled donation after circulatory determination of death (cDCDD) protocols is by some regarded as controversial and ethically troublesome. One of the main concerns that opponents have about introducing NRP in cDCDD protocols is that reestablishing circulation will negate the determination of death by circulatory criteria, potentially resuscitating the donor. In this article, I argue that this is not the case. If we take a closer look at the concept of death underlying the circulatory criterion for determination of death, we find that the purpose of the criterion is to show whether the organism as a whole has died. I argue that this purpose is fulfilled by the circulatory criterion in cDCDD protocols, and that applying NRP does not negate the determination of death or resuscitate the donor. [ABSTRACT FROM AUTHOR]

Organ donation after the circulatory determination of death requires the permanent cessation of circulation while organ donation after the brain determination of death requires the irreversible cessation of brain functions. The unified brain-based determination of death connects the brain and circulatory death criteria for circulatory death determination in organ donation as follows: permanent cessation of systemic circulation causes permanent cessation of brain circulation which causes permanent cessation of brain perfusion which causes permanent cessation of brain function. The relevant circulation that must cease in circulatory death determination is that to the brain. Eliminating brain circulation from the donor ECMO organ perfusion circuit in thoracoabdominal NRP protocols satisfies the unified brain-based determination of death but only if the complete cessation of brain circulation can be proved. Despite its medical and physiologic rationale, the unified brain-based determination of death remains inconsistent with the Uniform Determination of Death Act. [ABSTRACT FROM AUTHOR]

An adult university hospital ethics committee evaluated a proposed TA-NRP protocol in the fall of 2018. The protocol raised ethical concerns about violation of the Uniform Determination of Death Act and the prohibition known as the Dead Donor Rule, with potential resultant legal consequences. An additional concern was the potential for increased mistrust by the community of organ donation and transplantation. The ethics committee evaluated the responses to these concerns as unable to surmount the ethical and legal boundaries and the ethics committee declined to endorse the procedure. These concerns endure. [ABSTRACT FROM AUTHOR]

The article presents the discussion on key points from Lewis' manuscript. Topics include judiciary-based approach does not defer to widespread public input or debate on a new way to determine whether an individual is alive or dead; and considers an area of law that does not fall under federal jurisdiction, but which would benefit from uniformity in approach across states.

The article presents the discussion on Philosophers and theologians contest its moral significance, clinicians and bioscientists debate its probative accuracy. Topics include death determination in clinical settings should involve an informational exchange between clinicians and patient surrogate decision makers; and admit different criteria for determining death, individuals and families should be made aware of the implications of applying one criterion over another.

The article presents the discussion on introduction of a new criterion for determining death. Topics include completely dysfunctional is a purely scientific and biomedical matter, the moral and legal implications of this diagnosis transcend the boundaries of science; and circulatory and respiratory functions cease, and/or the suspicion that DNC is motivated by the opportunity for organ retrieval.

Although medicolegal challenges to the use of neurologic criteria to declare death in the USA have been well-described, the management of court cases in the United Kingdom about objections to the use of neurologic criteria to declare death has not been explored in the bioethics or medical literature. This article (1) reviews conceptual, medical and legal differences between death by neurologic criteria (DNC) in the United Kingdom and the rest of the world to contextualize medicolegal challenges to DNC; (2) summarizes highly publicized legal cases related to DNC in the United Kingdom, including the nuanced 2022 case of Archie Battersbee, who was transiently considered dead by neurologic criteria, but ultimately determined to be in a vegetative state/unresponsive-wakeful state; and (3) provides an overview of ethical issues raised by medicolegal challenges to DNC in the United Kingdom and a comparison to the management of these challenges in the USA. [ABSTRACT FROM AUTHOR]

The article discusses a study on distinguishing ethical from diagnostic concerns about NRP-cDCD, conducted by Kyle E. Karches and Jason T. Eberl, published in the journal "The American Journal of Bioethics." It examines arguments by Bernat and Busch regarding the diagnostic certainty of death in NRP-cDCD, while also addressing ethical objections related to the intentionality of actions performed during NRP.

The article discusses a study on the legal and ethical implications of normothermic regional perfusion (NRP) conducted by L. Syd M Johnson, published in the journal "The American Journal of Bioethics." It examines the compatibility of NRP, particularly thoraco-abdominal NRP (TA-NRP), with the unified brain-based determination of death (UBDD), arguing that TA-NRP may invalidate UBDD and violate the Dead Donor Rule (DDR) due to concerns about the restoration of brain circulation.

The article discusses a study on normothermic regional perfusion (NRP) amidst ethical controversy, conducted by Erica Andrista and Matthew P. Kirschen, published in the journal "The American Journal of Bioethics." It compares the implementation of NRP in organ donation after cardiac death to past controversies surrounding brain death determination, highlighting the importance of public engagement and dialogue to ethically navigate the boundaries between life and death in medical practice.

The article discusses a study on the declaration, determination, and concept of death in the context of organ donation after circulatory determination of death (DCDD), conducted by Kathleen N. Fenton and Anne Dalle Ave, published in the journal "The American Journal of Bioethics." It examines the ethical and practical implications of declaring death before the irreversible cessation of respiratory and circulatory functions, particularly in DCDD programs.

The article discusses a study on normothermic regional perfusion (NRP) conducted by Tamar Schiff and Arthur Caplan, published in the journal. It addresses ethical concerns regarding the use of NRP in organ recovery, particularly in relation to the dead donor rule (DDR) and the need for transparency, informed decision-making, and improvement in organ donation practices.

The article critiques the Uniform Determination of Death Act (UDDA) for its failure to clearly align with medical practices, particularly in defining death by circulatory-respiratory criteria, especially concerning normothermic regional perfusion for organ donation.It mentions that despite efforts to revise the UDDA, challenges persist due to varying perspectives and political constraints, leaving unresolved discrepancies between medical protocols and legal standards.

The article argues that Thoracoabdominal Normothermic Regional Perfusion (TA-NRP) challenges the determination of death by circulatory criteria because it can restore circulation after it has ceased, undermining the legal requirement for irreversible circulatory cessation. IT mentions that the current legal interpretation already considers permanent cessation of function as sufficient for circulatory death determination, without needing to amend laws to a unified brain-based definition.

The article explores concerns regarding the potential erosion of public trust in organ transplantation due to the implementation of normothermic regional perfusion (NRP) and its implications for violating the dead donor rule (DDR). It also discusses the broader context of organ donation, including the increasing demand for organs, racial disparities in waiting times, and efforts to address inefficiencies in the organ allocation system.

The article discusses a study where an adult university hospital ethics committee evaluated a proposed protocol for normothermic regional perfusion (NRP) in 2018. It mentions that the protocol raised concerns about ethical and legal boundaries related to the Uniform Determination of Death Act and the Dead Donor Rule, leading the committee to decline endorsement due to unsatisfactory answers to these concerns.

The article presents the discussion on cross-jurisdictional legal approaches to brain death. Topics include England and Wales, Scotland, and Northern Ireland, each with their own court structures and, in the case of Scotland, a different type of legal system; and courts of England and Wales operate in a hierarchical fashion, with cases of medical significance involving children.

The article presents the discussion on exclusion of confounders and reversibility of the patient's condition," as reflected in the UK Code of Practice for the Diagnosis and Confirmation of Death in 2008. Topics include directly relevant to this situation given the conceptual differences in DNC between the USA and the UK; and panel of physicians, lawyers, ethicists and religious leaders were involved in defining death in 1981.

The article presents the discussion on countries have adopted a total brain standard for determining death. Topics include reducing the discrepancy between legal and ethical formulations of death and potentially increasing organ donations; and Several cases involving significant brain injury but not total brain have spurred legal battles as well as broader public debates on life, death, and personhood.

The vital status of patients who are a part of controlled donation after circulatory death (cDCD) is widely debated in bioethical literature. Opponents to currently applied cDCD protocols argue that they violate the dead donor rule, while proponents of the protocols advocate compatibility. In this article, we argue that both parties often misinterpret the moral implications of the dead donor rule. The rule as such does not require an assessment of a donor's vital status, we contend, but rather an assessment of whether procurement of organs in cDCD cause the death of the donor or not. We then argue that commonly practiced cDCD protocols do not violate the dead donor rule, since the donation does not trigger or cause the death of the donors. [ABSTRACT FROM AUTHOR]

The article delves into James Bernat's proposal of a unified brain-based determination of death, emphasizing the permanent cessation of brain function as the primary criterion. It mentions that while this concept has theoretical appeal, its enthusiastic promotion may overlook practical and ethical challenges, particularly in its application to normothermic regional perfusion (NRP) and donation after circulatory determination of death (DCDD).

The author comments on the article "Does Controlled Donation After Circulatory Death Violate the Dead Donor Rule (DDR)?," by Nielsen Busch et al., taking into account as to whether transparency is good for organ donation. They discuss the distinct meanings of the dead donor rule considering the Don't Kill rule and the Death Requirement rule. He considers an essay about brain death by Yale law professor Robert Burt indicating that the existing brain death criteria are incoherent.

The authors comment on the article "Does Controlled Donation After Circulatory Death Violate the Dead Donor Rule (DDR)?," by Nielsen Busch et al., asserting that the analysis is lacks explanation to address questions about the ethical legitimacy of normothermic regional perfusion with controlled donation after circulatory death (NRP-cDCD) applied to organs outside the abdominal cavity. They contend that the use of NRP-cDCD complicates the analysis.

The author comments on the article "Does Controlled Donation After Circulatory Death Violate the Dead Donor Rule (DDR)?," by Nielsen Busch et al., focusing on the Dead Donor Rule as applied to the dead and living. He examines the role of rules in transplant medicine by comparing the DDR to the living donor rule which requires first-person consent for the retrieval of an organ from a living person.

The author comments on the article "Does Controlled Donation After Circulatory Death Violate the Dead Donor Rule (DDR)?," by Nielsen Busch et al., arguing that the acceptance of controlled donation following cardiac death (cDCD) is morally insufficient. They focus on the arguments that cDCD organ extraction procedures risk using the patient/donor for the benefit of the organ recipient and that the donor's consent does not exempt treating the donor disrespectfully.

The authors comment on the article "Does Controlled Donation After Circulatory Death Violate the Dead Donor Rule (DDR)?," by Nielsen Busch et al., focusing on omission of the procurement of the heart during controlled donation after circulatory death. They discuss the procedure for and ethical issues of thoracoabdominal normothermic regional perfusion (TA-NRP). They explain whether ligation or division of the aortic arch vessels that supply the brain is necessary in TA-NRP.

The author comments on the article "Does Controlled Donation After Circulatory Death Violate the Dead Donor Rule (DDR)?," by Nielsen Busch et al., exploring two premises of their argument that controlled donation after circulatory death and normothermic regional perfusion do not contradict the dead donor rule. They are organ procurement not leading to death of the donor is enough to satisfy the DDR and death is the loss of the patient's capacity to function as an integrated whole.

The author comments on the article "Does Controlled Donation After Circulatory Death Violate the Dead Donor Rule (DDR)?," by Nielsen Busch et al., contending that their case remains incomplete as it disregard the conflict of interest problem in controlled donation after circulatory death (cDCD) protocols and cDCD-normothermic regional perfusion. He explores the Don't Kill interpretation and Death Requirement interpretation, citing the debate over the permissibility of imminent death donation.

The article focuses on ethical and legal requirement for informed surrogate consent prior to conducting an apnea test as part of the diagnosis of death by neurologic criteria. Topics inlcude the apnea testing is a medical procedure that increases the risk of significant iatrogenic harm, the surrogates have a broad and well-recognized right to refuse unwanted medical procedures, and the two premises because we judged them to be the most straightforward has accepted among available options.

The article focuses on requiring family authorization for apnea testing subtracts health professionals control over death determination, a procedure that has traditionally been considered a matter of clinical expertise alone. Topics inlcude the health professionals' (HPs) disposition to act, the death determination without family's prior consent could be much lower than that referred to by Berkowitz and Garrett, and the HPs may have reservations about their own expertise as regards death.

The past decade has witnessed escalating legal and ethical challenges to the diagnosis of death by neurologic criteria (DNC). The legal tactic of demanding consent for the apnea test, if successful, can halt the DNC. However, US law is currently unsettled and inconsistent in this matter. Consent has been required in several trial cases in Montana and Kansas but not in Virginia and Nevada. In this paper, we analyze and evaluate the legal and ethical bases for requiring consent before apnea testing and defend such a requirement by appealing to ethical and legal principles of informed consent and battery and the right to refuse medical treatment. We conclude by considering and rebutting two major objections to a consent requirement for apnea testing: (1) a justice-based objection to allocate scarce resources fairly and (2) a social utility objection that halting the diagnosis of brain death will reduce the number of organ donors. [ABSTRACT FROM AUTHOR]

The authors comment on the article "Does Controlled Donation After Circulatory Death Violate the Dead Donor Rule (DDR)?," by Nielsen Busch et al., focusing on the challenges related to concerns about the DDR contradicts controlled donation after circulatory death (cDCD) protocols and the loss of recoverable organs. They focus on acknowledging clinicians' concern about death and cDCD protocols and administrative, psychosocial or ethical issues that pose challenges for organ procurement experts.

The author comments on the article "Does Controlled Donation After Circulatory Death Violate the Dead Donor Rule (DDR)?," by Nielsen Busch et al., discussing the consequence of violating the dead donor rule. She contends that the study authors' argument that the Donation after Circulatory Death does not violate the rule is false and that it destroys the public trust needed for organ donation.

The article focuses on unpredictable patients diagnosis with death by neurological criteria (DNC) and mentions harm caused by overriding parent's denial in case of Maddie Reece who died of drowning. Topics discussed include team helped to understand perspective of patients through parental objection, trust between team and family promoted by testing for DNC, and empathy offered to parents of Maddie in their grief.

The authors comment on an article by McGuire and colleagues on the ethical dilemma faced by hospitals in the practice of organ donation and procurement with respect to the rationing of scarce critical care resources during the COVID-19 pandemic. Topics covered include the absence of ethical issues surrounding the practice of organ donation and transplantation in the article; the problem of shared scare resources; the nature, relationship, and recipients of the generated benefits.

An editorial is presented on the Uniform Determination of Death Act (UDDA) to assure a consistent nationwide approach to consent for brain death testing. Topics inlcude the open peer commentaries (OPCs) contend that informed consent being not required for apnea testing, the most common argument challenges one of Berkowitz and Garret's premises, that the apnea test being a treatment, and the apnea test being not itself health care, but rather a means to determine whether health care.

The article focuses on Schrödinger's Cat and the ethically untenable act of not looking. Topics inlcude the supposition that the act of performing the brain death exam is what creates the reality of death, the physicians who deploy invasive technological interventions have a fundamental responsibility to determine its ongoing appropriateness, and the boundary between life and death in the modern intensive care unit has proven challenging to pinpoint.

The article focuses on the ethically and legally mandatory for physicians to obtain has informed consent prior to performing an apnea test. Topics inlcude the argue that without informed consent from a legally authorized representative, the conclusion that has informed consent has required being correct, and the basis for this premise derives from a standard of care framework rather than a battery framework.

The article focuses on the apnea test an argument to broaden the requirement for consent to the entire brain death evaluation. Topics inlcude the highlight persistent controversies in the determination of death by neurologic criteria (DNC), the argument for consent in terms only of the apnea evaluation, rather than the entire evaluation for determining DNC, and the diagnosis of respiratory failure does not require the physical examination of the lungs as part of diagnosis does require consent.

The article focuses on the constitutive elements of responsible ventilator management and the apnea test. Topics inlcude the setting of challenging clinical disagreements between families of patients and treating teams about the obligations of treating a patient who may soon be found to be dead, the important to understand and fully appreciate sound clinical, and the clinical justification for the apnea test being confirmation of a patient's vital status.

The article focuses on the informed consent being ethically and legally required for apnea testing because it entails substantial risks without direct benefits. Topics inlcude the developments in apnea testing and mischaracterizes safety data, the ignores other similar clinical practices which separate has informed consent being not required, and the assertion has informed consent has intended to prolong the treatment of individuals being likely to fulfill the neurological criteria for death.

The article focuses on argument claiming surrogate consent to brain-death testing should be ethically and legally required. Topics inlcude the categorization of brain-death testing as a form of medical treatment, testing is a medical procedure encompassed within a broader framework of invasive clinical treatment, and the risk of complications associated with stopping the ventilator during an apnea examination.

The article focuses on accommodating apnea testing not death determination refusal. Topics inlcude the Uniform Determination of Death Act (UDDA) has accepted standards include both cardiorespiratory and neurologic criteria on equal footing to diagnose the same unitary phenomenon, the identification of irreversible cessation of circulation and breathing or brain function in children, and the and adults, and the large degree internationally has been constitutes medical and legal death.

The article focuses on the case against solicitation of consent for apnea testing. Topics inlcude apnea testing has been medical procedure necessitating consent, the right to refuse treatment has been applicable for the apnea testing, and the brain death has exam being unique from other medical testing.

The article focuses on apnea testing being medical treatment requiring informed consent. Topics include the test being a compulsory component of the American Academy of Neurology's ("AAN") guidelines for brain death diagnosis, mandating that physicians obtain a surrogate's consent to the test would impede their ability to declare a patient dead using neurological criteria, and the temporary withdrawal of life support rather than the imposition of medical treatment on a patient.

The article focuses on decision-making in the determination of death by neurologic criteria. Topics inlcude the goals of care for critically ill patients should be determined through a shared decision-making (SDM), the intensive care unit (ICU) with severe neurologic illness or injury, clinicians should employ a SDM process to determine what goals the team will pursue, and the ICU teams being empathetic, they can better match the needs of families in real time.