The diagnosis of brain death in Japan compared to the global consensus: minimum clinical criteria for determination of brain death and death by neurologic criteria

Abstract

The world consensus on brain death and death by neurologic criteria (BD/DNC) was published in 2020. In this consensus, BD/DNC requires confirmation of deep coma, loss of brainstem reflexes, and apnea, but does not require loss of activity in electroencephalogram (EEG), which is required to determine brain death in Japan. This is because EEG is ineffective in assessing brainstem function. Furthermore, ancillary tests and the use of positive end-expiratory pressure during apnea tests are recommended contents to be included in the Japanese procedure. Considering the current situation in Japan, it is necessary to achieve consistency with the international consensus. The international consensus on brain death criteria was summarized in this manuscript, with differences and concerns compared to the current situation in Japan.