Abstract
Purpose
Despite general worldwide acceptance of the concept of neurological determination of death (NDD), inconsistencies in clinical criteria and ancillary testing requirements remain. Numerous guidelines for NDD may be applied in clinical practice by a variety of medical practitioners, but the scientific rationale for specific guideline recommendations often remains unclear. This review examines the evolution of NDD, and seeks to provide scientific validation for existing NDD criteria.
Source
English language peer-reviewed medical journals and established contemporary medical texts.
Principal findings
Currently published guidelines appear to have evolved from the work of the ad hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death. The Conference of the Royal Colleges and Faculties of the United Kingdom refined the criteria and subsequently adopted the principal of brainstem death. While the fundamentals of NDD guidelines are remarkably consistent worldwide, specific criteria and requirements are often inconsistent.
Conclusion
Numerous controversies regarding NDD continue to exist, necessitating further scientific clarification of these issues. More recently published guidelines representing the collective opinion of world experts in NDD based upon best current scientific evidence are available in current medical journals.
Résumé
Objectif
Malgré ľacceptation mondiale du concept de détermination neurologique de la mort (DNM), un manque ďhomogénéité persiste dans les critères cliniques et les exigences de tests accessoires. De nombreuses directives peuvent être appliquées pour la DNM par divers praticiens médicaux cliniques, mais le fondement scientifique des recommandations de pratique demeure souvent confus. La présente revue examine ľévolution de la DNM et cherche à donner une validation scientifique aux critères existants de DNM.
Source
Des revues médicales de langue anglaise vérifiées par des pairs et des textes médicaux contemporains reconnus.
Constatations principales
Les directives publiées présentement paraissent avoir évolué depuis le premier travail du Comité spécial de la Harvard Medical School chargé de définir la mort encéphalique. La Conference of the Royal Colleges and Faculties of the United Kingdom a raffiné les critères et subséquemment adopté le principe de mort du tronc cérébral. Quoique le fondement des directives sur la DNM soit remarquablement cohérent à travers le monde, les exigences et les critères spécifiques sont souvent irréguliers.
Conclusion
Beaucoup de controverse continue ďexister en regard de la DNM, ce qui nécessite une clarification scientifique poussée. Des directives publiées plus récemment sont accessibles. Elles font part de ľopinion collective ďexperts mondiaux en DNM, fondée sur la meilleure preuve scientifique actuelle.
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Baron, L., Shemie, S.D., Teitelbaum, J. et al. Brief review: History, concept and controversies in the neurological determination of death. Can J Anesth 53, 602–608 (2006). https://doi.org/10.1007/BF03021852
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DOI: https://doi.org/10.1007/BF03021852