Death: irreversible or permanent?

The most recent guidelines for determining brain death restrict diagnostic criteria to the demonstration of a “permanent” loss of either brain or cardiopulmonary function. This approach departs from the conventional understanding of “death”, which is defined by “irreversibility” rather than mere “permanence”. Current guidelines in Canada, the USA and the UK, as well as a draft guideline from Switzerland, do not provide convincing justification for this conceptual shift. By adopting permanence as the operative standard, these guidelines risk undermining the dead donor rule, which requires that organ retrieval occur only after death has been definitively established.