Irreversibility: cardiac death versus brain death.

The acceptance of brain death (BD) as death of the human being has been progressively accepted beginning in the early 1960s. The issue of irreversibility is directly related to the diagnosis of human death, and it is closely associated with the concept of potentiality, i.e., that some patients still have the potentiality of living. In recent years several authors have proposed to use a cardiocirculatory criterion for death determination in transplant donors. This has aroused ethical and medical controversies regarding concerns to accept that a non-heart-beating donor is really dead. We conclude that the cardiocirculatory criterion of death only assures irreversibility when asystole is prolonged enough to assure that ischemia and anoxia have destroyed the brain. On the contrary, BD fulfills both requirements for death determination: cessation of functions and irreversibility