NEUROLOGICAL DETERMINATION OF DEATH AND ITS APPLICATION IN PRACTICE
Peter N. Cox*
MBChB, FFARCS, FRCPC, Professor, Anaesthesia & Paediatrics, University of Toronto, Clinical Director, Critical Care Unit, Department of Critical Care Medicine, The Hospital for Sick Children. *
The management of patients with severe brain injury falls within the disciplines of emergency medical services, trauma, critical care, neurology and neurosurgery. Consultation and collaboration of these disciplines with stakeholders involved in end of life care, organ donation and transplantation is required to standardize and optimize the management of severely brain injured patients who evolve to neurological death.

Despite the widespread national, international and legal acceptance of the concept of death as defined by neurological criteria, substantial variability exists in these standards and their application. In all Canadian provinces and territories, brain death is defined as 'according to accepted medical practice'. These practices are largely determined by individual hospitals or regions. Surveys locally concur with international observations that significant inconsistencies and variability exist in the application of these practices. While guidelines do exist in Canada, they have not led to uniform practice.

Acknowledging variability in the recognition, diagnosis and documentation of neurological death, a prerequisite for organ donation, the Canadian Council for Donation and Transplantation sponsored a recent forum with the intent of establishing recommendations clarifying the many issues surrounding concepts of neurological death.

These recommendations will be discussed in detail during the session.
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