«The Brain as a Whole» Concept: Facilitating Approaches to Brain Death Understanding

James Bernat claimed that «the formulation of whole-brain death provides the most congruent map for our correct understanding of death». However, the author has recently proposed the categorization of another phrase: «brain as a whole (BAAW)». This is because patients with primary brainstem lesions who otherwise meet the clinical criteria for BD may still have EEG, CBF, evoked potentials, and hypothalamic-pituitary neurosecretion. Bernat and colleagues suggested «tightening the clinical tests for brain death or loosening the whole-brain criterion of death». They emphasize that the BAAW criterion is an intermediate standard between the whole-brain and brainstem views, tolerating the irreversible cessation of critical brain functions, whereas the BD/DNC determination does not require the cessation of all brain functions or the death of every neuron. In this paper, we have revised the concept of BAAW, which is intuitive and facilitates a conceptual and practical approach, but requires further refinement to specify precisely which brain functions must cease at brain death and which may continue.