Brain-based Definition of Death and Evidence based Criteria for its Determination after Arrest of Circulation or Neurologic Function in Canada
Developing a Brain-based Definition of Death and Evidence-based Criteria for its Determination after Arrest of Circulation or Neurologic Function in Canada
Project update - May 2023
A Brain-based Definition of Death and Evidence based Criteria for its Determination after Arrest of Circulation or Neurologic Function in Canada: a 2023 clinical practice guideline was published in a special edition of the Canadian journal of Anesthesia alongside 28 supporting papers.
This new Canadian clinical practice guideline contains a single, brain-based definition of death: Death is defined as the permanent cessation of brain function as defined by the absence of consciousness and brainstem reflexes including the ability to breathe independently.
This new guideline clarifies that all death is a result of the permanent loss of brain function; promotes consistency in practice; minimizes risk for diagnostic error; fosters trust and integrity in system; and addresses legal and ethical challenges.
The publication is a rigorously developed clinical practice guideline which provides the biomedical definition of death based on permanent cessation of brain function that applies to all persons, as well as recommendations for death determination by circulatory criteria for potential organ donors and death determination by neurologic criteria for all mechanically ventilated patients regardless of organ donation potential.
Project background
When proceeding with deceased organ donation, a clear definition and determination of death are of critical importance. The concepts currently in practice have created the idea of two distinct forms of death – brain death and cardiac death.
However, cardiac death is indeed brain death. That is, arrest of circulation leads to absent brain blood flow, which in turn leads to the rapid loss of brain function.
There is a need to review and update Canadian clinical practice guidelines, including the definition of death, to align practices with current scientific evidence and address evolving legal and ethical considerations.
Objectives
The objective of this project is to develop a clinical practice guideline that includes a brain-based definition of death as well as evidence-based and expert-informed criteria for death determination after arrest of circulation or neurologic function
- A Brain-based Definition of Death and Evidence based Criteria for its Determination after Arrest of Circulation or Neurologic Function in Canada: a 2023 clinical practice guideline Shemie, S.D., Wilson, L.C., Hornby, L. et al.
- Editors’ Note: The evolution of critical care content in the Journal and a “special” Special Issue Schwarz, S.K.W., Jones, P.M. Can J Anesth/J Can Anesth (2023). https://doi.org/10.1007/s12630-023-02406-5
- Answering global challenges to the determination of death: consensus-building leadership from Canada Gardiner, D., Greer, D.M., Bernat, J.L. et al. Can J Anesth/J Can Anesth (2023). https://doi.org/10.1007/s12630-023-02423-4
- An updated practice guideline for death determination: one giant leap for the field led by Canada Greer, D.M. Can J Anesth/J Can Anesth (2023). https://doi.org/10.1007/s12630-023-02405-6
- What does "brainstem death" mean? A review of international protocols Spears WE, Lewis A, Bakkar A, Kreiger-Benson E, Kumpfbeck A, Liebman J, Sung G, Torrance S, Shemie SD, Greer DM. Can J Anaesth. 2023 May 2. English. doi: 10.1007/s12630-023-02428-z. Epub ahead of print. PMID: 37131037
- Brain-based arterial pulse pressure threshold for death determination: a systematic review Lalgudi Ganesan, S., Hornby, L., Weiss, M. et al. Can J Anesth/J Can Anesth (2023). https://doi.org/10.1007/s12630-023-02425-2
- Delayed recovery from severe refractory intracranial hypertension due to expansion of skin and pericranium stretch after decompressive craniectomy Cunan ET, Dudley RWR, Shemie SD. Can J Anaesth. 2023 May 2. English. doi: 10.1007/s12630-023-02429-y. Epub ahead of print. PMID: 37131036
- Ancillary investigations for death determination in infants and children: a systematic review and meta-analysis McKinnon NK, Maratta C, Zuckier LS, Boyd JG, Chassé M, Hornby L, Kramer A, Kromm J, Mooney OT, Muthusami P, Nitulescu R, Park J, Slessarev M, Basmaji J. Can J Anaesth. 2023 May 2. English. doi: 10.1007/s12630-023-02418-1. Epub ahead of print. PMID: 37131035
- Infratentorial brain injury and death by neurologic criteria in Canada: a narrative review Shemie, S.D., Briard, J.N., Boyd, J.G. et al. Can J Anesth/J Can Anesth (2023). https://doi.org/10.1007/s12630-023-02427-0
- Diagnostic test accuracy for cessation of circulation during death determination: a systematic review Klowak, J.A., Nguyen, AL.V., Malik, A. et al. Can J Anesth/J Can Anesth (2023). https://doi.org/10.1007/s12630-023-02424-3
- Ancillary radionuclide perfusion studies in the determination of death by neurologic criteria: methods, interpretation, and lexicon-a user guide for the clinician Zuckier LS, McKinnon NK. Can J Anaesth. 2023 May 2. English. doi: 10.1007/s12630-023-02420-7. Epub ahead of print. PMID: 37131034
- Diagnostic accuracy of ancillary tests for death by neurologic criteria: a systematic review and meta-analysis Neves Briard, J., Nitulescu, R., Lemoine, É. et al. Can J Anesth/J Can Anesth (2023). https://doi.org/10.1007/s12630-023-02426-1
- Radionuclide scintigraphy as an ancillary test for death determination in infants under 2 months of age McKinnon, N.K., Basmaji, J. Can J Anesth/J Can Anesth (2023). https://doi.org/10.1007/s12630-023-02419-0
- The reticular activating system: a narrative review of discovery, evolving understanding, and relevance to current formulations of brain death Taran, S., Gros, P., Gofton, T. et al. Can J Anesth/J Can Anesth (2023). https://doi.org/10.1007/s12630-023-02421-6
- Autoresuscitation after circulatory arrest: an updated systematic review Zorko, D.J., Shemie, J., Hornby, L. et al. Can J Anesth/J Can Anesth (2023). https://doi.org/10.1007/s12630-023-02411-8
- Knowledge gaps in the definition and determination of death Maitre G, Shemie SD, Baker A, Chassé M, Hornby L, Sarti AJ, Teitelbaum J, Dhanani S. Can J Anaesth. 2023 May 2. doi: 10.1007/s12630-023-02422-5. Epub ahead of print. PMID: 37131033
- Nontherapeutic research with imminently dying and recently deceased study populations: addressing practical and ethical challenges Murphy, N.B., Weijer, C., Lalgudi Ganesan, S. et al. Can J Anesth/J Can Anesth (2023). https://doi.org/10.1007/s12630-023-02414-5
- Legal considerations for the definition of death in the 2023 Canadian Brain-Based Definition of Death Clinical Practice Guideline Chandler, J.A., Pope, T.M. Can J Anesth/J Can Anesth (2023). https://doi.org/10.1007/s12630-023-02410-9
- Consent for determination of death by neurologic criteria in Canada: an analysis of legal and ethical authorities, and consensus-based working group recommendations Pope TM, Chandler JA, Hartwick M. Can J Anaesth. 2023 May 2. English. doi: 10.1007/s12630-023-02430-5. Epub ahead of print. PMID: 37131032
- Trust and conflict in death determination—reflections on the legacy of Taquisha McKitty Stewart, S., McKitty, A., Chidwick, P. et al. Can J Anesth/J Can Anesth (2023). https://doi.org/10.1007/s12630-023-02443-0
- Balancing values: implications of a brain-based definition of death for pluralism in Canada Murphy, N.B., Chandler, J.A., Hartwick, M. et al. Can J Anesth/J Can Anesth (2023). https://doi.org/10.1007/s12630-023-02408-3
- Implications of the updated Canadian Death Determination Guidelines for organ donation interventions that restore circulation after determination of death by circulatory criteria Murphy, N.B., Weijer, C., Slessarev, M. et al. Can J Anesth/J Can Anesth (2023). https://doi.org/10.1007/s12630-023-02413-6
- Navigating disagreement and conflict in the context of a brain-based definition of death Simpson C, Lee-Ameduri K, Hartwick M, Shaul RZ, Kanji A, Healey A, Murphy NB, Pope TM. Can J Anaesth. 2023 May 2. English. doi: 10.1007/s12630-023-02417-2. Epub ahead of print. PMID: 37131031
- Potential pharmacological confounders in the setting of death determined by neurologic criteria: a narrative review Kanji S, Williamson D, Hartwick M. Can J Anaesth. 2023 May 2. English. doi: 10.1007/s12630-023-02415-4. Epub ahead of print. PMID: 37131030
- Death determination by neurologic criteria-what do families understand? Sarti AJ, Sutherland S, Meade M, Hornby L, Wilson LC, Landriault A, Vanderspank-Wright B, Valiani S, Keenan S, Weiss MJ, Werestiuk K, Beed S, Kramer AH, Kawchuk J, Cardinal P, Dhanani S, Lotherington K, Pagliarello G, Chassé M, Gatien M, Parsons K, Chandler JA, Nickerson P, Shemie S; Canadian Critical Care Trials Group (CCCTG). Can J Anaesth. 2023 May 2. English. doi: 10.1007/s12630-023-02416-3. Epub ahead of print. PMID: 37131029
- Variability in criteria for death determination in the intensive care unit Shemie, J., Scales, N.B., Sucha, E. et al. Can J Anesth/J Can Anesth (2023). https://doi.org/10.1007/s12630-023-02412-7
- When is a person dead? The Canadian public's understanding of death and death determination: a nationwide survey Sarti AJ, Honarmand K, Sutherland S, Hornby L, Wilson LC, Priestap F, Carignan R, Joanne B, Brewster H, Elliott-Pohl K, Weiss M, Shemie SD. Can J Anaesth. 2023 May 2. English. doi: 10.1007/s12630-023-02409-2. Epub ahead of print. PMID: 37131025
- Rationale for revisions to the definition of death and criteria for its determination in Canada Murphy NB, Hartwick M, Wilson LC, Simpson C, Shemie SD, Torrance S, Chandler JA. Can J Anaesth. 2023 May 2. English. doi: 10.1007/s12630-023-02407-4. Epub ahead of print. PMID: 37131021
- The Critical Care Commute Podcast: Life, Death and the Bridges in Between, interview with Dr. Sam Shemie, part 1 & part 2
- Healthcare Professionals’ Understandings of the Definition and Determination of Death: A Scoping Review Zheng, Katina MD; Sutherland, Stephanie PhD; Hornby, Laura MSc; Wilson, Lindsay MHA; Shemie, Sam D. MD; Sarti, Aimee J. MD
- Video
- Checklist | Liste de contrôle
- Death Determination by Circulatory Criteria (DCC) - English
- Liste de contrôle pour la détermination du décès selon des critères circulatoires (DCC) pour les donneurs d’organes potentiels DCC - French
- Checklist | Liste de contrôle
- Death Determination by Neurologic Criteria (DNC) - English
- Liste de contrôle pour la détermination du décès selon des critères neurologiques (DNC) - French
- Clinical Pathway | FlowCharts
- Poster
Project Resource Dropbox Folder
If you require addtional support or accessible versions of any of the resource documents, please contact OTDT@blood.ca
The Organ Donation and Transplantation Collaborative is an initiative led by Health Canada with provinces and territories (except Québec), Canadian Blood Services, patients, families, clinicians and researchers. Funded by Health Canada, the project Developing a Brain-based Definition of Death and Evidence-based Criteria for its Determination after Arrest of Circulation or Neurologic Function in Canada contributes to the Collaborative’s vision to achieve organ donation and transplantation system improvements that result in better patient outcomes and an increase in the number and quality of successful transplantations. For more information, please consult the Organ Donation and Transplantation Collaborative (the Collaborative) website: https://tinyurl.com/ODTCollaborative.