The whole-brain criterion for death requires the absence of all functions of the entire brain. It follows logically that the preservation of any function of any part of the brain is not consistent with the whole-brain criterion for death. The hypothalamus is a part of the brain and has been shown to continue functioning in up to 50% of patients declared dead by neurologic criteria. Therefore, up to 50% of patients declared dead under the whole-brain criterion for death are false-positive misdiagnoses. Numerous responses have been offered to explain why preserved hypothalamic function is consistent with the whole-brain criterion for death. All these responses fail.
- Brain death
- Diabetes insipidus
- False positive
- Determination of death by neurologic criteria
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President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Biobehavioral Research. Defining death: a report on the medical, legal and ethical issues in the determination of death. Washington, DC: U.S. Government Printing Office; 1981.
Academy of Medical Royal Colleges. A Code of Practice for the Diagnosis and Confirmation of Death; 2008. http://aomrc.org.uk/wp-content/uploads/2016/04/Code_Practice_Confirmation_Diagnosis_Death_1008-4.pdf.
Green MB, Wikler D. Brain death and personal identity. Philos Public Aff. 1980;9(2):105–33.
McMahan J. The ethics of killing: problems at the margins of life. Oxford: Oxford University Press; 2002.
Lizza JP. Persons, humanity, and the definition of death. Baltimore: The Johns Hopkins University Press; 2006.
Bernat JL, Dalle Ave AL. Aligning the criterion and tests for brain death. Camb Q Healthc Ethics. 2019;28(4):635–41.
Dalle Ave AL, Bernat JL. Inconsistencies between the criterion and tests for brain death. J Intensive Care Med. 2020;35(8):772–80.
Shewmon DA. Statement in support of revising the Uniform Determination of Death Act and in opposition to a proposed revision. J Med Philos. 2021; online ahead of print. https://doi.org/10.1093/jmp/jhab014.
Greer DM, Shemie SD, Lewis A, et al. Determination of brain death/death by neurologic criteria. The World Brain Death Project. JAMA. 2020;324(11):1078–97.
Wijdicks EF, Varelas PN, Gronseth GS, Greer DM. Evidence-based guideline update: determining brain death in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2010;74(23):1911–8.
Shemie SD, Hornby L, Baker A, et al. International guideline development for the determination of death. Intensive Care Med. 2014;40(6):788–97.
Swaab DF, Buijs RM, Kreier F, Lucassen PJ, Salehi A. Preface. In: Swaab D, Buijs RM, Kreier F, Lucassen PJ, Salehi A, editors. Handbook of clinical neurology vol. 182 (3rd series). The human hypothalamus: neuropsychiatric disorders. Amsterdam: Elsevier; 2021.
Blumenfeld H. Neuroanatomy through clinical cases. Sunderland, MA: Sinauer Associates, Inc.; 2002.
Nair-Collins M, Joffe AR. Frequent preservation of neurologic function in brain death and brainstem death entails false-positive misdiagnosis and cerebral perfusion. AJOB Neurosci. 2021. Online ahead of print. https://doi.org/10.1080/21507740.2021.1973148.
Nair-Collins M, Joffe AR. Hypothalamic function in patients diagnosed as brain dead and its practical consequences. In: Swaab D, Buijs RM, Kreier F, Lucassen PJ, Salehi A, editors. Handbook of clinical neurology vol. 182 (3rd series). The human hypothalamus: neuropsychiatric disorders. Amsterdam: Elsevier; 2021.
Nair-Collins M, Northrup J, Olcese J. Hypothalamic-pituitary function in brain death: a review. J Intensive Care Med. 2016;31:41–50.
Bourque CW. Central mechanisms of osmosensation and systemic osmoregulation. Nat Rev Neurosci. 2008;9:519–31.
Outwater KM, Rockoff MA. Diabetes insipidus accompanying brain death in children. Neurology. 1984;34(9):1243–6.
Powner DJ, Snyder JV, Grenvik A. Brain death certification: a review. Crit Care Med. 1977;5(5):230–3.
Russell JA, Epstein LG, Greer DM, et al. AAN position statement. Brain death, the determination of brain death, and member guidance for brain death accommodation requests. Neurology. 2019;92:1–5.
Bernat JL. The whole-brain concept of death remains optimum public policy. J Law Med Ethics. 2006;34(1):35–43.
Wijdicks EF. The case against confirmatory tests for determining brain death in adults. Neurology. 2010;75(1):77–83.
Nair-Collins M. Taking science seriously in the debate on death and organ transplantation. Hast Cent Rep. 2015;45:38–48.
Lewis A, Bonnie RJ, Pope T. It’s time to revise the Uniform Determination of Death Act. Ann Intern Med. 2020;172(2):143–4.
Lewis A, Bonnie RJ, Pope T, et al. Determination of death by neurologic criteria in the United States: the case for revising the Uniform Determination of Death Act. J Law Med Ethics. 2019;47(S4):9–24.
Magnus DC, Wilfond BS, Caplan AL. Accepting brain death. N Engl J Med. 2014;370(10):891–4.
Some of the ideas for this chapter are drawn from an earlier published manuscript . I gratefully acknowledge my coauthor Dr. Ari Joffe for collaboration on this earlier paper, and thank him for permission to rearticulate some of those ideas in the present chapter.
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Nair-Collins, M. (2022). Preserved Hypothalamic Function Is Not Consistent with the Whole-Brain Criterion for Death. In: Lewis, A., Bernat, J.L. (eds) Death Determination by Neurologic Criteria. Advances in Neuroethics. Springer, Cham. https://doi.org/10.1007/978-3-031-15947-3_7
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