Brain Death Sans Frontières

To the Editor: Clinical criteria make it possible to be brain dead in one country and not in another. This has implications for international organ-retrieval programs. A 2530-g male infant was delivered at 37 weeks' gestation by emergency cesarean section because of profound fetal bradycardia. There was asystole at birth. A satisfactory cardiac output was established within five minutes. At 41 hours the infant's condition fulfilled the Canadian criteria for brain death,¹ with no response to stimuli and absence of all brain-stem reflexes — pupillary light, corneal, oculocephalic, vestibulo-ocular, and pharyngeal. An electrocardiogram was isoelectric, and brain-stem auditory evoked potentials.