rmtОбщая реаниматологияGeneral Reanimatology1813-97792411-7110FSBI "SRIGR" RAMS10.15360/1813-9779-2025-2-27-02rmt-2565Research ArticleЭТИЧЕСКИЕ И ЮРИДИЧЕСКИЕ ВОПРОСЫETHICAL AND LEGAL ISSUESЭтические императивы для согласования стандартов констатации смерти мозга в США и во всем миреEthical Imperatives for Harmonizing Brain Death Standards in the United States and Globallyhttps://orcid.org/0000-0002-0539-5844МачадоК.MachadoC.

10400, Ла-Гавана, ул. Ведадо, д. 29 y D

Calixto Machado.

29 y D Vedado, 10400 La Habana

cmachado180652@gmail.comСанчесХ.SanchezJ. J.

33125, Флорида, Майами, Северо-западная 15-я ул. Роуд,1545

Jose J. Sanchez.

1545 NW 15th Street Road, Miami, FL 33125

https://orcid.org/0000-0002-0833-9493СаниоваБ.  Д.SaniovaB. D.

03601, Мартин, ул. Колларова, д. 2

Beata Drobna Saniova.

2 Kollarova Str., 03659 Martin

https://orcid.org/0000-0001-9312-558XДробныМ.DrobnýM.

03601, Мартин, ул. Колларова, д. 2

Michal Drobný.

2 Kollarova Str., 03659 Martin

ШиффА.SchiffA.

30046, Джорджия, Лоуренсвилл, бульвар Медицинского центра, д. 500, каб. 350

Arthur Schiff.

500 Medical Center Blvd, Suite 350, Lawrenceville, GA 30046

Институт неврологии и нейрохирургии, кафедра клинической нейрофизиологииКубаInstitute of Neurology and Neurosurgery, Department of Clinical NeurophysiologyCubaАгентство Better CallСоединённые Штаты АмерикиBetter Call AgencyUnited StatesКлиника анестезиологии и интенсивной медицины, Братиславский университет им. Коменского, медицинский факультет им. Ессениуса и Университетская клиника в МартинеСловакияClinic of Anaesthesiology and Intensive Medicine, Comenius University in Bratislava, Jessenius Faculty of Medicine and University Hospital in MartinSlovakiaБольница Нортсайд ГвиннеттСоединённые Штаты АмерикиNorthside Hospital GwinnettUnited States2025230420252126871Copyright © Мачадо К., Санчес Х.J., Саниова Б.Д., Дробны М., Шифф А., 20252025Мачадо К., Санчес Х., Саниова Б.Д., Дробны М., Шифф А.Machado C., Sanchez J.J., Saniova B.D., Drobný M., Schiff A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.reanimatology.com/rmt/article/view/2565

Определение смерти мозга/смерти по неврологическим критериям (СМ/СНК) является важнейшим медицинским и юридическим процессом. Закон о единообразном определении смерти (The Uniform Determination of Death Act, UDDA) обеспечивает правовую основу для этого процесса, однако в разных штатах сохраняются значительные расхождения в его интерпретации и применении. Эти различия порождают этические проблемы, связанные с правосудием, самостоятельностью пациента, информированным согласием и доверием общества к врачебной констатации смерти.

В данной статье приводятся аргументы в пользу срочного согласования критериев СМ/СНК в США и во всем мире для соблюдения этических норм в медицинской практике, обеспечения непрерывности в медицинском уходе в конце жизни и сохранения общественного доверия к системе донорства органов. Рассматриваются этические аспекты, включая справедливость доступа к медицинским услугам, уважение религиозных и культурных убеждений, а также последствия для политики получения органов. Призыв к стандартизации на национальном и международном уровнях согласуется с принципами биоэтики и передовой медицинской практикой, направленными на укрепление этической и правовой целостности при определении СМ/СНК.

The determination of brain death/death by neurological criteria (BD/DNC) is a critical medical and legal process. The Uniform Determination of Death Act (UDDA) provides a legal framework, yet significant state-by-state inconsistencies persist in its interpretation and implementation. These disparities create ethical concerns related to justice, patient autonomy, informed consent, and public trust in medical determinations of death.

This paper argues for urgently harmonizing BD/DNC criteria across the United States and globally to up-hold ethical medical practice, ensure consistency in end-of-life care, and preserve public confidence in the organ donation system.

Ethical considerations are examined, including fairness in healthcare access, respect for religious and cultural beliefs, and the implications for organ procurement policies. The call for national and international standardization aligns with bioethical principles and medical best practices, aiming to reinforce ethical and legal integrity in BD/DNC determination.

смерть мозгасмерть по неврологическим критерияммедицинская этикаправосудиеобщественное довериеправовые стандартыглобальная политика здравоохранениядонорство органовинформированное согласиеbrain deathdeath by neurological criteriamedical ethicsjusticepublic trustlegal standardsglobal health policyorgan donationinformed consentReferencesAllemang B., Patton M., Greer K., Pinston K., Farias M., Schofield K., Samuael S., et al. Development of the Strengths, Skills, and Goals Matrix: a tool for facilitating strengths-based adolescent and young adult engagement in research. Res Involv Engagem. 2023; 9 (1): 89. DOI: 10.1186/s40900-023-00502-w.Allemang B., Patton M., Greer K., Pinston K., Farias M., Schofield K., Samuael S., et al. Development of the Strengths, Skills, and Goals Matrix: a tool for facilitating strengths-based adolescent and young adult engagement in research. Res Involv Engagem. 2023; 9 (1): 89. DOI: 10.1186/s40900-023-00502-w.Berkowitz I. D., Garret J. Should the brain death exam with apnea test require surrogate informed consent? No. The U. D. DA revision series. Neurology. 2023; 101 (5): 218–220. DOI: 10.1212/WNL.0000000000207343. PMID: 37429709.Berkowitz I. D., Garret J. Should the brain death exam with apnea test require surrogate informed consent? No. The U. D. DA revision series. Neurology. 2023; 101 (5): 218–220. DOI: 10.1212/WNL.0000000000207343. PMID: 37429709.Barnes E., Greer D. Inconsistency in brain death determination should not be tolerated. AMA J Ethics. 2020; 22 (12): E1027-1032. DOI: 10.1001/amajethics.2020.1027. PMID: 33419503.Barnes E., Greer D. Inconsistency in brain death determination should not be tolerated. AMA J Ethics. 2020; 22 (12): E1027-1032. DOI: 10.1001/amajethics.2020.1027. PMID: 33419503.Lewis A., Kirschen M.P, Greer D. M. Author response: pediatric and adult brain death/death by neurologic criteria consensus guideline: report of the AAN Guidelines Subcommittee, AAP, CNS, and SCCM. Neurology. 2024; 102 (9): e209370. DOI: 10.1212/WNL.0000000000209370. PMID: 38648607.Lewis A., Kirschen M.P, Greer D. M. Author response: pediatric and adult brain death/death by neurologic criteria consensus guideline: report of the AAN Guidelines Subcommittee, AAP, CNS, and SCCM. Neurology. 2024; 102 (9): e209370. DOI: 10.1212/WNL.0000000000209370. PMID: 38648607.Bernat J. L. Author response: challenges to brain death in revising the uniform determination of Death Act: the UDDA revision series. Neurology.2024; 102 (1): e208045. DOI: 10.1212/WNL.0000000000208045. PMID: 38165387.Bernat J. L. Author response: challenges to brain death in revising the uniform determination of Death Act: the UDDA revision series. Neurology.2024; 102 (1): e208045. DOI: 10.1212/WNL.0000000000208045. PMID: 38165387.Machado C. Reader response: challenges to brain death in revising the uniform determination of death act: the UDDA revision series. Neurology. 2024; 102 (1): e208044. DOI: 10.1212/WNL.0000000000208044. PMID: 38165388Machado C. Reader response: challenges to brain death in revising the uniform determination of death act: the UDDA revision series. Neurology. 2024; 102 (1): e208044. DOI: 10.1212/WNL.0000000000208044. PMID: 38165388Machado C. Reader response: What is the ideal brain criterion of death? Nonclinical considerations: the UDDA revision series. Neurology. 2024; 102 (9): e209286. DOI: 10.1212/WNL.0000000000209286. PMID: 38621220.Machado C. Reader response: What is the ideal brain criterion of death? Nonclinical considerations: the UDDA revision series. Neurology. 2024; 102 (9): e209286. DOI: 10.1212/WNL.0000000000209286. PMID: 38621220.Landau D., Kirschen M. P., Greer D., Lewis A. States do not delineate the «Accepted Medical Standards» for brain death/death by neurologic criteria determination. Neurocrit Care. 2025. DOI: 10.1007/s12028-024-02209-6. PMID: 39849222.Landau D., Kirschen M. P., Greer D., Lewis A. States do not delineate the «Accepted Medical Standards» for brain death/death by neurologic criteria determination. Neurocrit Care. 2025. DOI: 10.1007/s12028-024-02209-6. PMID: 39849222.Johnson L. S.M. Philosophical, medical, and legal controversies about brain death. Elements in bioethics and neuroethics. Cambridge University Press; 2024: 84. DOI: 10.1017/9781009323352Johnson L. S.M. Philosophical, medical, and legal controversies about brain death. Elements in bioethics and neuroethics. Cambridge University Press; 2024: 84. DOI: 10.1017/9781009323352Kowalski K., Marschollek J., Nowakowska-Kotas M., Budrewicz S. The impact of clinical education on knowledge and attitudes towards brain death among Polish medical students — a cross-sectional study. BMC Med Educ. 2023; 23 (1): 669. DOI: 10.1186/s12909-023-04637-y. PMID: 37710211.Kowalski K., Marschollek J., Nowakowska-Kotas M., Budrewicz S. The impact of clinical education on knowledge and attitudes towards brain death among Polish medical students — a cross-sectional study. BMC Med Educ. 2023; 23 (1): 669. DOI: 10.1186/s12909-023-04637-y. PMID: 37710211.Junga A., Kockwelp P., Valkov D., Schulze H., Bozdere P., Hätscher O., Ahrens H., et al. Teach the unteachable with a virtual reality (VR) brain death scenario — 800 students and 3 years of experience. Perspect Med Educ. 2025; 14 (1): 44–54. DOI: 10.5334/pme.1427. PMID: 39897616.Junga A., Kockwelp P., Valkov D., Schulze H., Bozdere P., Hätscher O., Ahrens H., et al. Teach the unteachable with a virtual reality (VR) brain death scenario — 800 students and 3 years of experience. Perspect Med Educ. 2025; 14 (1): 44–54. DOI: 10.5334/pme.1427. PMID: 39897616.Amiri M., Fisher P. M., Raimondo F., Sidaros A., Hribljan M. C., Othman M. H., Zibrandtsen I., et al. Multimodal prediction of residual consciousness in the intensive care unit: the CONNECT-ME study. Brain. 2023; 146 (1): 50–64. DOI: 10.1093/brain/awac335. PMID: 36097353.Amiri M., Fisher P. M., Raimondo F., Sidaros A., Hribljan M. C., Othman M. H., Zibrandtsen I., et al. Multimodal prediction of residual consciousness in the intensive care unit: the CONNECT-ME study. Brain. 2023; 146 (1): 50–64. DOI: 10.1093/brain/awac335. PMID: 36097353.Taran S., Gros P., Gofton T., Boyd G., Briard J. M., Chassé M., Singh J. M. The reticular activating system: a narrative review of discovery, evolving understanding, and relevance to current formulations of brain death. Can J Anaesth. 2023; 70 (4): 788–795. DOI: 10.1007/s12630-023-02421-6. PMID: 37155119.Taran S., Gros P., Gofton T., Boyd G., Briard J. M., Chassé M., Singh J. M. The reticular activating system: a narrative review of discovery, evolving understanding, and relevance to current formulations of brain death. Can J Anaesth. 2023; 70 (4): 788–795. DOI: 10.1007/s12630-023-02421-6. PMID: 37155119.Rizk A. A., Farhani N., Shankar J. Computed tomography perfusion for the diagnosis of brain death: a technical review. Can J Neurol Sci. 2024; 51 (2): 173–178. DOI: 10.1017/cjn.2023.242. PMID: 37462465.Rizk A. A., Farhani N., Shankar J. Computed tomography perfusion for the diagnosis of brain death: a technical review. Can J Neurol Sci. 2024; 51 (2): 173–178. DOI: 10.1017/cjn.2023.242. PMID: 37462465.Murphy N. B., Shemie S. D., Capron A., Truog R. D. Nakagawa T., Healey A., Gofton T., et al. Advancing the scientific basis for determining death in controlled organ donation after circulatory determination of death. Transplantation. 2024; 108 (11): 2197–2208. DOI: 10.1097/TP.0000000000005002. PMID: 38637919.Murphy N. B., Shemie S. D., Capron A., Truog R. D. Nakagawa T., Healey A., Gofton T., et al. Advancing the scientific basis for determining death in controlled organ donation after circulatory determination of death. Transplantation. 2024; 108 (11): 2197–2208. DOI: 10.1097/TP.0000000000005002. PMID: 38637919.Diaz-Cobacho G., Molina-Perez A., Rodriguez-Arias D. Death pluralism: a proposal. Philos Ethics Humanit Med. 2023; 18 (1): 10. DOI: 10.1186/s13010-023-00139-3. PMID: 37528432.Diaz-Cobacho G., Molina-Perez A., Rodriguez-Arias D. Death pluralism: a proposal. Philos Ethics Humanit Med. 2023; 18 (1): 10. DOI: 10.1186/s13010-023-00139-3. PMID: 37528432.Eisenberg L. R. Disputes over diagnosing death: is it ethical to test for death by neurologic criteria over parental objection? Am J Bioeth. 2023; 23 (1): 86–87. DOI: 10.1080/15265161.2023.2146408. PMID: 36594995.Eisenberg L. R. Disputes over diagnosing death: is it ethical to test for death by neurologic criteria over parental objection? Am J Bioeth. 2023; 23 (1): 86–87. DOI: 10.1080/15265161.2023.2146408. PMID: 36594995.Lewis A. Should the revised uniform determination of death act address objections to the use of neurologic criteria to declare death? Neurocrit Care. 2022; 37 (2): 377–385. DOI: 10.1007/s12028-022-01567-3. PMID: 35854082.Lewis A. Should the revised uniform determination of death act address objections to the use of neurologic criteria to declare death? Neurocrit Care. 2022; 37 (2): 377–385. DOI: 10.1007/s12028-022-01567-3. PMID: 35854082.Lewis A., Kitamura E. The intersection of neurology and religion: a survey of hospital chaplains on death by neurologic criteria. Neurocrit Care. 2021; 35 (2): 322–334. DOI: 10.1007/s12028-021-01252-x. PMID: 34195896.Lewis A., Kitamura E. The intersection of neurology and religion: a survey of hospital chaplains on death by neurologic criteria. Neurocrit Care. 2021; 35 (2): 322–334. DOI: 10.1007/s12028-021-01252-x. PMID: 34195896.Afif I. N., Goldberg A. J., Zhao H., O’Shaughnessy G. D., Kling S. M., Nathan H. M., Hasz R. D., et al. Formal training improves resident understanding and communication regarding brain death/death by neurologic criteria. J Surg Educ. 2022; 79 (1): 198–205. DOI: 10.1016/j.jsurg.2021.08.018. PMID: 34507909.Afif I. N., Goldberg A. J., Zhao H., O’Shaughnessy G. D., Kling S. M., Nathan H. M., Hasz R. D., et al. Formal training improves resident understanding and communication regarding brain death/death by neurologic criteria. J Surg Educ. 2022; 79 (1): 198–205. DOI: 10.1016/j.jsurg.2021.08.018. PMID: 34507909.Lewis A., Kitamura E., Padela A. I. Allied Muslim healthcare professional perspectives on death by neurologic criteria. Neurocrit Care 2020; 33 (2): 347–357. DOI: 10.1007/s12028-020-01019-w. PMID: 32556858.Lewis A., Kitamura E., Padela A. I. Allied Muslim healthcare professional perspectives on death by neurologic criteria. Neurocrit Care 2020; 33 (2): 347–357. DOI: 10.1007/s12028-020-01019-w. PMID: 32556858.Lewis A. A Survey of multidenominational rabbis on death by neurologic criteria. Neurocrit Care. 2019; 31 (2): 411–418. DOI: 10.1007/s12028-019-00742-3. PMID: 31218638.Lewis A. A Survey of multidenominational rabbis on death by neurologic criteria. Neurocrit Care. 2019; 31 (2): 411–418. DOI: 10.1007/s12028-019-00742-3. PMID: 31218638.Atabekov T. A., Sazonova S. I., Khlynin M. S., Muslimova E.F., Krivolapov S.N., Kurlov I.O., Rebrova T.Yu., et al. Predictors of appropriate therapies delivered by the implantable cardioverter-defibrillator in patients with coronary artery disease during long-term period. Int J Cardiovasc Imaging. 2024; 40 (9): 1863–1874. DOI: 10.1007/s10554-024-03172-1. PMID: 38963590.Atabekov T. A., Sazonova S. I., Khlynin M. S., Muslimova E.F., Krivolapov S.N., Kurlov I.O., Rebrova T.Yu., et al. Predictors of appropriate therapies delivered by the implantable cardioverter-defibrillator in patients with coronary artery disease during long-term period. Int J Cardiovasc Imaging. 2024; 40 (9): 1863–1874. DOI: 10.1007/s10554-024-03172-1. PMID: 38963590.Damaiyanti M., Amir H., Cahyani D.D, Alhidayat N.S., Afrianti N., Rahmiati C., Hastuti H., et al. Improving caregiver preparedness in the care transition of stroke patients: a scoping review. J Med Life. 2023; 16 (12): 1723–1731. DOI: 10.25122/jml-2023-0142. PMID: 38585525.Damaiyanti M., Amir H., Cahyani D.D, Alhidayat N.S., Afrianti N., Rahmiati C., Hastuti H., et al. Improving caregiver preparedness in the care transition of stroke patients: a scoping review. J Med Life. 2023; 16 (12): 1723–1731. DOI: 10.25122/jml-2023-0142. PMID: 38585525.Ferhatoglu M. F., Ferhatoglu S. Y. A Holistic assessment of organ transplantation activities, scientific productivity on brain death in Islamic countries, and comparison of the outcomes with the United Nations Development statistics. J Relig Health. 2021; 60 (2): 774–786. DOI: 10.1007/s10943-020-01157-7. PMID: 33415604.Ferhatoglu M. F., Ferhatoglu S. Y. A Holistic assessment of organ transplantation activities, scientific productivity on brain death in Islamic countries, and comparison of the outcomes with the United Nations Development statistics. J Relig Health. 2021; 60 (2): 774–786. DOI: 10.1007/s10943-020-01157-7. PMID: 33415604.

The authors declare that there are no conflicts of interest present.