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J Crit Care. 2014 Aug;29(4):673-8. doi: 10.1016/j.jcrc.2014.04.015. Epub 2014 Apr 26.

History of brain death as death: 1968 to the present.

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Maxeen Stone and John A. Flower Professor of Neurology, Case Western Reserve University School of Medicine, Center for Neurocritical Care, Neurological Institute, University Hospitals Case Medical Center, 11100 Euclid Ave, Cleveland, OH 44106-5040. Electronic address:


The concept of brain death was formulated in 1968 in the landmark report A Definition of Irreversible Coma. While brain death has been widely accepted as a determination of death throughout the world, many of the controversies that surround it have not been settled. Some may be rooted in a misconstruction about the history of brain death. The concept evolved as a result of the convergence of several parallel developments in the second half of the 20th century including advances in resuscitation and critical care, research into the underlying physiology of consciousness, and growing concerns about technology, medical futility, and the ethics of end of life care. Organ transplantation also developed in parallel, and though it clearly benefited from a new definition of death, it was not a principal driving force in its creation. Since 1968, the concept of brain death has been extensively analyzed, debated, and reworked. Still there remains much misunderstanding and confusion, especially in the general public. In this comprehensive review, I will trace the evolution of the definition of brain death as death from 1968 to the present, providing background, history and context.


Brain death; Critical Care; End-of-life care; Organ transplantation; Resuscitation

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