**7. Determination of death**

As discussed earlier in the chapter, declaration of death—whether that be circulatory death or brain death—has been a controversial topic over the years. In 2014, an international forum was held in Montreal, Canada with the objective to provide a functional definition of death that encompassed the concepts of brain and circulatory death. They reported that "Death is the permanent loss of capacity for consciousness and all brainstem functions. This may result from permanent cessation of circulation or catastrophic brain injury. In the context of death determination, 'permanent' refers to loss of function that cannot resume spontaneously and will not be restored through intervention" [58]. It is important for health care practitioners of all levels working with potential donor patients to have a good understanding of the definition of death in order to be able to explain to grieving families the reality of the situation and its finality [59]. It is well established that adequate explanation of brain death is one of the critical components of the donation process [60]. The optimal timing of the consent process is also of great importance [61]. Checklists are helpful in maintaining the thoroughness of brain death determination, but do not replace the expertise, knowledge and compassion of physicians in end-of-life discussions with families of the potential donor.
