Table 1 Timeline of influential authors that explicitly make the BD Hypothesis the standard medical and legal rationale for why BD has been accepted as a criterion for death of the organism

Korein; 1978 [19]

A main member of the medical consultants to the President’s Commission explaining, for a scientific forum on death, the standard concept of why brain death is equivalent to death

If the critical system, i.e., the brain, in a man is destroyed, the human organism is no longer in a state of minimal entropy production; its state will progressively become more disorganized by spontaneous irreversible fluctuations… irreversible cardiac arrest will inevitably follow regardless of maintenance of all resuscitative procedures… most often these final irreversible changes occur prior to 48 hours and even 24 hours after brain death.

26-27

Defining death: medical, legal and ethical issues in the determination of death; 1981 [12]

The President’s Commission that explicitly explained the concept of why brain death is equivalent to biological death

What was formerly a person is now a dead body and can be socially and legally treated as such. Although absence of breathing and heartbeat may often have been spoken of as "defining" death, review of history and of current medical and popular understanding makes clear that these were merely evidence for the disintegration of the organism as a whole, as discussed in Chapter Three.

58

The first focuses on the integrated functioning of the body's major organ systems, while recognizing the centrality of the whole brain, since it is neither revivable nor replaceable. The other identifies the functioning of the whole brain as the hallmark of life because the brain is the regulator of the body's integration.

32

On this view, death is that moment at which the body's physiological system ceases to constitute an integrated whole. Even if life continues in individual cells or organs, life of the organism as a whole requires complex integration, and without the latter, a person cannot properly be regarded as alive.

33

This view gives the brain primacy not merely as the sponsor of consciousness (since even unconscious persons may be alive), but also as the complex organizer and regulator of bodily functions. (Indeed, the "regulatory" role of the brain in the organism can be understood in terms of thermodynamics and information theory). Only the brain can direct the entire organism. Artificial support for the heart and lungs, which is required only when the brain can no longer control them, cannot maintain the usual synchronized integration of the body.

34

[Absent all brain functions] even with extraordinary medical care, [vital] functions cannot be sustained indefinitely – typically, no longer than several days.

35

The bifurcated legal standard for determining death: does it work; 1999 [20]

Alexander Capron, a drafter of the UDDA, explaining why brain death and cardiocirculatory criteria both meet the standard concept of death

…confirmed the existing concept of death as a phenomenon diagnosable by the two alternative methods… The circle of integrated functioning was broken, however it was assessed.

125

…crystalizes the contemporary understanding of death because it illustrates how some of an organism’s vital parts remain functional even though the organism has died, namely, lost its ability to perform as an integrated whole because some essential element (typically, the brain) can no longer function and cannot be replaced.

126

Controversies in the determination of death: a white paper by the President’s Council on Bioethics; 2008

[13]

The President’s Council that explicitly re-addressed the standard concept of why brain death is equivalent to death

The neurological standard’s early defenders were not wrong to seek such a principle of wholeness. They may have been mistaken, however, in focusing on the loss of somatic integration as the critical sign that the organism is no longer a whole. They interpreted—plausibly but perhaps incorrectly— “an organism as a whole” to mean “an organism whose parts are working together in an integrated way.”

59-60

Interdisciplinary panel convened with support from the Health Resources and Services Administration Division of Transplantation; 2010 [21]

An international panel convened to address whether donation after cardiocirculatory death donors meet the standard concept of death

In its 1981 report Defining Death, the U.S. President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research provided the most frequently cited comprehensive analysis. Defining Death had three principal goals: 1) to provide a conceptual basis for the new medical practice of death determination using neurological tests…

963

American Academy of Neurology multisociety quality improvement intitiative, 2018

[22]

A summit “to address, and potentially correct, aspects of brain death determination within the purview of medical practice that may have contributed to these lawsuits”

After an extensive review, the Commission concluded that brain death should be endorsed as legal death, and produced the Uniform Determination of Death Act (UDDA)…

424

Just as cardiopulmonary death is determined when there is irreversible loss of circulatory and respiratory function, brain death is defined by irreversible loss of consciousness and brainstem function leading to the inability to breathe independent of artificial support, and ultimately results in the demise and decay of all organ systems.

426