Brain Death with Prolonged Somatic Survival

To the Editor: In the January 7 issue, Parisi et al.¹ incorrectly concluded that the Harvard, Minnesota, and National Institute of Neurological and Communicative Disorders and Stroke collaborative study criteria for brain death were satisfied on either Day 3 or Day 6. These criteria^{2 3 4} and the recently published “Guidelines for the Determination of Death”⁵ indicate that if Central-nervous-system depressants (such as barbiturates) are present, isoelectric electroencephalograms cannot reliably confirm brain death. It is erroneous to conclude that this patient's electroencephalograms were not affected by the phenobarbital simply because the phenomenon is rare, or that lower blood barbiturate levels do not.