by Fr. Dennis Gonzales
There is a common belief that the heart is the source of vital functions that sustain life. For many centuries, death is declared when the heart stops to beat. The absence of heart function eventually leads to the cessation of the respiratory, central nervous, and other bodily systems.
In 1968, a group of physicians and researchers from Harvard Medical School determined another criterion of death, called the brain-death criteria. The aim of this criterion was twofold. The first one is to address the issue of patients whose brain may no longer be functioning, but who have been dependent on ventilators and other life-sustaining measures for a long period of time. The second one is to formulate guidelines for determining death in organ transplantation. The Harvard criteria became generally accepted, which subsequently become the basis of the Uniform Determination of Death Act in the early 1980s, where brain death is legally recognized as an acceptable indication of death. Today, all fifty states and the District of Columbia permit the use of brain death for death determination.
The two accepted legal criteria for determining death are cardiac death and brain death
We now follow two criteria in determining death. The first is the traditional practice based on the circulatory-respiratory cessation, or the cardiac criteria or non-heart beating criteria. The second is based on cessation of neurological responses or the brain-death criteria. Brain death criteria may be used to determine the death of a person when the cardiopulmonary criteria may not be available or may be difficult to implore because machines or ventilators artificially supply heart and lung functions. These machines may camouflage death.
These two criteria are both accepted guidelines. A person who has sustained either irreversible cessation of circulatory and respiratory functions or irreversible cessation of all functions of the entire brain, including the brain stem is dead.
The brain has three anatomic divisions: the cerebrum or higher brain, the cerebellum or midbrain, and the brainstem or lower brain. Brain stem death is equated with the death of the individual because it controls functions such as respiration, yawning and swallowing. Brain death occurs when significant damage to the brain destroys the brain’s ability to regulate respiratory function.
The Church does not object to either cardiac or brain death criteria
The Church does not object to either criteria of death. The Pontifical Academy of Science conforms that death criteria that focus on the loss of functions of either the entire brain or heart are morally acceptable. The Pontifical Academy of Science further explains that:
The concept of brain death does not seek to promote the notion that there is more than one form of death. Rather, this specific terminology relates to a particular state, within a sequence of events, that constitutes the death of an individual. Thus brain death means the irreversible cessation of all the vital activity of the brain (the cerebral hemispheres and the brain stem). This involves an irreversible loss of function of the brain cells and their total, or near total, destruction.
The Catholic Church subjects the definition of death to the realm of medicine. The determination of death must be made with accepted medical standards. The American Academy of Neurology practice parameters suggests determination of brain dead should consider major findings that include the presence of unresponsive coma, the absence of brainstem reflexes and absence of respiratory drive after a carbon dioxide challenge. Careful examination of the case and history of the patient is also important. Other tests that may be used to confirm brain death may include transcranial doppler ultrasound, computed tomography, magnetic resonance imaging, electroencephalography, and nuclear brain scanning. Confirmatory tests may be determined according to hospital policy.
A brain-death criterion is employed in organ transplantation
A brain death criterion allows death to be determined in a timely manner and thereby enables organ transplantation. A loss of function in one vital organ system may often follow significant functional and structural damages or necrosis (death of a living cell) in other organ systems. Mechanical ventilation is often used to reinforce cardio-pulmonary functions in bodies pronounced as brain dead, for the organ to remain viable before procurement. Therefore, even though the patient is dead, the ventilator is still attached to the patient to provide oxygen to the vital organs.
When mechanical ventilation and support are continued for a body declared dead using brain-dead criteria, the heart continues to beat for some time due to the residue of blood and from the reflexes. Yet, despite the continued pumping of the heart, there is no question that the person is irreversibly dead. These physical manifestations might mislead us to believe that the patient is still alive. Persons had been revived after the cessation of breathing and heartbeat through cardiopulmonary resuscitation. No one, however, had ever been revived after the brain had died. The brain, as the center of the nervous system, serves the basic integrative organ of the body. “The death of the brain, then, constituted unquestionable death.”
The ventilator and not the individual’s natural life artificially maintains the appearance of the vitality of the body. Thus, in a condition of brain death, the so-called life of the parts of the body is “artificial life” and not natural life. A medical instrument has become the principal cause of residual functioning. In this way, death is camouflaged or masked using ventilators or life-support machines.
Death as a process may continue to manifest residual signs of life that will quickly cease in a short time. Kenneth Iserson offers an analogy by citing that an individual who had lost all brain functions is dead. He describes that when the body is physiologically decapitated, the head is cut off, the heart continues to beat. Iserson uses the wisdom from the Talmud that says, “The death of a decapitated man is not signs of life any more than the twitching of a lizard’s amputated tail.”
Despite legal acceptance of brain death criteria, social and cultural obstacles are not easily and completely eliminated. There are still controversies concerning the acceptance of brain- death criteria. There are also some personal stories claiming that “people who were declared brain dead” were able to “wake-up again” and recover. These stories may invite a cloud of suspicion of the brain death criteria. It is important that families and the society, in general, should be educated on the care afforded to every person to avoid misconception and doubts about the legal criteria of death.
Patients who are in a PVS or coma state are not brain dead
The Catholic Church clarifies that something essential distinguishes brain death from all other types of severe brain dysfunction that encompass alterations of consciousness. A state of coma, persistent vegetative state, and the minimally conscious state are not brain death. The Church asserts that if the criteria for brain death are not met and confirmed by expert neurological examination, death does not happen, no matter how severe and irreversible a brain injury may be.
The Church is committed to ensure that individuals who donate vital organs are dead before procurement begins. The generous nature of freely-chosen organ donation is praiseworthy. It is a decision to offer part of one’s body for the health and well-being of another person and to give him/her hope for another chance to live.
Individuals who agree to become an organ donor offer an ultimate act of charity and compassion to others. The bereaved family members are given the opportunity to see the tangible good that comes from their loss. Pope John Paul II speaks of this heroic act of generosity, which “are the most solemn celebration of the Gospel of Life, for they proclaim it by the total gift of self.” 
 Samantha Weyrauch, “Acceptance of Whole-Brain Death Criteria for determination of Death: A Comparative Analysis of the United States and Japan,” UCLA Pacific Basin Law Journal, 17(1) (January 01, 1999): 91, https://escholarship.org/content/qt5wg908hk/qt5wg908hk.pdfSamantha Weyrauch, 92.  Samantha Weyrauch, 91.  Sherry H-Y Chou, MD, MMSc, Neurological Criteria for Death in Adults and Management of Donors. https://med.uth.edu/anesthesiology/files/2015/05/Chapter-4-Neurological-Criteria-for-Death-in-Adults-and-Management-of-Organ-Donors.pdf.  Samantha Weyrauch, 92.  David Kelly, 112.  Samantha Weyrauch, 92.  Ibid.  Pontifical Academy of Science, Why the Concept of Brain-death is Valid as a Definition of Death, The Proceedings of the Working Group of 11-12 September 2006, Scripta Varia 110, (Vatican City: The Pontifical Academy of Sciences, 2007), 6. http://www.priestsforlife.org/magisterium/brain-death.pdf  Pontifical Academy of Science, 6.  Sherry H-Y Chou, MD MMSc.  Sherry H-Y Chou, MD, MMSc.  James M. DuBois, “Determining Death” in Catholic Health Care Ethics: A Manual for Practitioners, 167.  Ibid.  John Hass, Catholic Teaching Regarding the Legitimacy of Neurological Criteria for the Determination of Death, The National Catholic Bioethics Quarterly 3 Summer 2011. https://www.ncbcenter.org/files/8014/4916/4378/Neuro_11_2_6_HaasArticle_279-299.pdf  Pontifical Academy of Science, Why the Concept of Brain-death is Valid as a Definition of Death, The Proceedings of the Working Group, 13. http://www.priestsforlife.org/magisterium/brain-death.pdf  Brian Kane, The Blessing of Life: An Introduction to Catholic Bioethics (New York, Lexington Press, 2011), 133.
 Brian Kane, The Blessings of Life, 133.  James M. Du Bois, “Determining Death” in Catholic Health Care Ethics:, A Manual for Practitioners, 174. John Paul II, Address to the Eighteenth International Congress of the Transplantation Society (August 29, 2000), n. 3, reprinted in National Catholic Bioethics Quarterly 1.1 (Spring 2001): 89–92, as cited by John Haas, Catholic Teaching regarding the Legitimacy of Neurological Criteria for the Determination of Death, The National Catholic Bioethics Quarterly 3 Summer 2011. https://www.ncbcenter.org/files/8014/4916/4378/Neuro_11_2_6_HaasArticle_279-299.pdf  Ibid.