Diagnosis of Brain Death and Organ Donation After Circulatory Death

  • Anthony A. Sochet
  • Alexandra K. Glazier
  • Thomas A. NakagawaEmail author


Determination of death and provision of organ transplantation can result in controversy for the pediatric provider caring for a critically ill or injured child. Despite accepted legal definitions for death and guidelines for neurologic and circulatory determination of death, there remains an evolving and, at times, contentious dialogue among medical experts and the community. We provide the historical context and summarization of several legal and clinical aspects to define death and discussion of potential ethical controversies regarding death by neurologic and circulatory criteria. We highlight conflicts and controversies raised by both family and healthcare team members that are becoming increasingly prevalent in our practice of critical care medicine. We offer insight and proposed solutions into matters of autonomy, maleficence, non-beneficence, and the respectful, dignified care of the sick and dying child and their family.


Brain death Donation after neurologic determination of death Donation after circulatory determination of death Ethics Pediatric Critical Care Medicine 



American Academy of Pediatrics


Cardiopulmonary resuscitation


Donation after circulatory determination of death


Donation after neurologic determination of death


Do not resuscitate


Organ procurement organization


Pediatric intensive care unit


Society of Critical Care Medicine


Uniform Anatomical Gift Act


Uniform Determination of Death Act


Withdrawal of life-sustaining therapies


Conflict of Interest

Dr. Sochet: None

Dr. Nakagawa: Received funding from Up To Date and Fresenius Kabi. Dr. Nakagawa is the Assistant Medical Director for Carolina Donor Services.

Ms. Glazier: None


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Anthony A. Sochet
    • 1
    • 2
  • Alexandra K. Glazier
    • 3
  • Thomas A. Nakagawa
    • 1
    • 2
    Email author
  1. 1.Anesthesiology and Critical Care MedicineThe Johns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Division of Pediatric Critical Care MedicineJohns Hopkins All Children’s HospitalSt. PetersburgUSA
  3. 3.New England Donor ServicesWalthamUSA

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