Key messages

• The diagnosis of death has evolved from recognition of the traditional signs (absence of heart sounds and pulse, and breathing) to the diagnosis of total brain death and, in some countries, to establishing death of the brainstem.

• Death can be conceived as a state in which there is irreversible loss of the capacity for consciousness combined with irreversible loss of the capacity to breathe (and hence maintain a heart beat). Neither would be sufficient alone.

• The diagnosis of brain death can be based on etiological preconditions (certain diagnosis of irremediable structural brain damage due to a disorder that can cause brain death), exclusion of certain specified conditions which might contribute to or cause the coma, and clinical testing.

• Once brain death has been confirmed, mechanical ventilation should be discontinued as soon as possible. This should not be viewed as withdrawing support to allow a patient to die, but rather as ceasing a futile intervention in a patient who is already dead.

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