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

Project Outputs and Publications

Additional resources to support clinicians in death determination for potential organ donors 

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.

Brain-based definition of death: Animated Video

World Brain Death Project: Implications for Canadian Practice

Brain blood flow in the neurological determination of death (2008)

Severe brain injury to neurological determination of death (NDD) - (2006)