Cerebral death is not a synonym of whole brain death

Dear Editor:

It was with great interest that we read the original article by Iriarte et al.¹ regarding university students’ concepts of death defined according to neurological criteria. We agree with the authors’ view that both health professionals and society at large should possess a basic knowledge of these concepts, and the medical and legal implications which they entail. However, we would like to call attention to the term ‘muerte cerebral’ or ‘cerebral death’ which the authors use throughout the manuscript. It is true that there is a lack of uniformity among the different definitions of brain death. It is also true that while firmly established standards for diagnosing brain death do exist, the standards vary greatly from country to country.^2–5 Some of the confusion arises from the way the term ‘brain death’, as defined by the Harvard criteria published in 1968, has been translated in Spanish.⁶ We are fully aware of the neuroanatomical differences between whole brain death, brainstem death, and neocortical or cerebral death. The first two definitions of death (based on neurological criteria) are the most widespread, and also the most polemic.^7–9 All of these definitions revolve around what they consider to be the ‘brain’ in ‘brain death’. On this topic, Spanish law as cited by Iriarte et al. clearly establishes that death must be diagnosed and certified based on “irreversible cessation of cardiopulmonary functions or brain functions”.¹⁰ For this reason, we feel that using ‘cerebral death’ as a synonym for whole brain death is confusing to both health care professionals and society at large. We understand that ‘muerte cerebral’ or ‘cerebral death’ is widely used by Spanish speakers, but the term should not be employed in medicine. If the concepts employed in our definitions are inappropriately explained, the definitions themselves are more likely to be misunderstood.