Dr. Heidi Klessig, a retired anesthesiologist, reveals the unsettling truth behind the modern definition of brain death and its deep ties to the organ transplant industry. In this Grand Rounds, she exposes the legal, medical, and ethical flaws in how death is declared, and why it matters more than most people realize.

Read about this class:

At the Zelenko Memorial Grand Rounds, Dr. Heidi Klessig, a retired anesthesiologist, delivered a striking and unsettling presentation on the controversial diagnosis of brain death, its origins, and its connection to the modern organ transplant industry. What began as a personal moment of confusion during her medical training has grown into decades of research and advocacy for what she calls a “reality-based” definition of death, and a call for urgent reform.

The Moment That Changed Everything

Dr. Klessig recounted her first experience anesthetizing a brain-dead patient for organ procurement. The patient looked alive—his skin was warm, he had a normal heart rate, good oxygen levels, and was even producing urine. She was instructed to provide anesthesia, including drugs to paralyze him and blunt his heart rate and blood pressure response during surgery.

When she asked whether she should use a drug to block consciousness, the supervising physician simply said, “Why don’t you give one just in case?”

That moment—watching a supposedly “dead” patient react to surgery just like any other—planted the seeds of deep doubt. Dr. Klessig began asking the question: what does it really mean to be dead?

Redefining Death for Utility, Not Biology

The modern definition of brain death was created in 1968 by a Harvard committee. The goal was not to reflect new medical understanding but to make organ donation possible and free up ICU beds. The committee redefined irreversible coma as death, without any new scientific evidence.

Dr. Klessig pointed out that this change served utility, not truth. “Does changing a definition change reality?” she asked. “If someone can be resuscitated, they were never dead.”

She explained the historical definition of death as the irreversible cessation of all vital functions—breathing, heartbeat, and circulation—confirmed over time. In contrast, the new definition allowed doctors to pronounce death based on assumptions about brain function.

What the Evidence Shows

A major study from 1970–1972—the only prospective multicenter study on brain death ever conducted—found that even among patients diagnosed as brain dead, many did not have total brain destruction at autopsy. Some brains were entirely normal. Even more shocking, Dr. Alan Shewmon later identified 175 cases of people who lived for days, weeks, or even years after being declared brain dead—some recovering fully.

These findings led to a 2008 Presidential Council reviewing the evidence again. But instead of abandoning neurological criteria, they redefined death once more using philosophical language. The term “total brain failure” was introduced and tied to vague, abstract ideas about the body's “vital work.”

According to Dr. Klessig, this definition was no longer about biology—it was about appearances and convenience.

The Reality Behind the Diagnosis

Despite legal claims that brain death is the “irreversible cessation of all brain function,” Dr. Klessig showed that the criteria used by doctors fall far short. The American Academy of Neurology (AAN) guidelines don’t test the entire brain. In fact:

• EEG testing is optional.

• Hypothalamic function—responsible for critical processes like temperature control, fluid balance, and hormone regulation—is often still present.

• Over 20% of diagnosed patients still have measurable brain waves.

• Many show physical signs of life: healing wounds, stable blood pressure, and even menstruation in some cases.

She shared the story of Zach Dunlap, who was declared brain dead based on a single brain flow scan. Just as his organs were about to be removed, he began moving—eventually recovering completely. He later said he heard everything during the process but was unable to respond.

Another case, Jahi McMath, was declared brain dead after a tonsillectomy and cardiac arrest. Her mother refused to accept the diagnosis and moved her to New Jersey, the only state with a religious exemption. Jahi later regained some awareness and bodily functions, even menstruating and following commands.

Global Ischemic Penumbra: The Power Outage in the Brain

Dr. Klessig explained a phenomenon called Global Ischemic Penumbra (GIP)—a state where brain function stops due to low blood flow, but the tissue remains alive. Like a home during a power outage, everything shuts down, but the system isn’t destroyed. Once blood flow improves, function may return.

This “power outage” can make people appear brain dead—flat EEGs, no reflexes—while the potential for recovery remains. Current brain death tests cannot reliably distinguish GIP from true brain death.

Legal and Ethical Chaos

In a landmark case, the Nevada Supreme Court ruled that the AAN brain death guideline did not meet the legal definition of death under the Uniform Determination of Death Act (UDDA). Despite this, the AAN continues to update its guidelines without legal alignment.

In fact, the 2023 AAN guideline now allows brain death to be declared even if part of the brain (like the hypothalamus) is still functioning. Their justification? A “novel evidence-informed formal consensus process”—essentially a series of anonymous votes among like-minded experts.

No new evidence. Just new words.

The Role of Organ Transplantation

Dr. Klessig made it clear: the transplant industry is driving the continued use of questionable death definitions. Organ procurement organizations benefit immensely from this system, and the financial incentives are enormous. The U.S. transplant industry is worth over $60 billion a year.

Even those involved in shaping brain death guidelines have admitted its primary purpose is transplantation. Dr. Peter Singer, a well-known ethicist, has called brain death “an ethical choice masquerading as a medical fact.”

Beyond Brain Death: More Controversial Practices

Dr. Klessig also discussed two related procedures:

• Donation after circulatory death (DCD): Patients who are not brain dead are removed from life support, and after just 2–5 minutes without a pulse (sometimes less), declared dead so their organs can be harvested.

• Normothermic Regional Perfusion (NRP): After DCD, circulation is restarted (except to the brain) using bypass machines, allowing the heart and other organs to function again before procurement.

These practices raise disturbing questions. If circulation can be restarted, was death ever truly irreversible?

The Risks of Donor Registration

Many people sign up as organ donors without understanding what it really means. Dr. Klessig warned that donor registration is legally binding—even overriding family objections in some cases. She encourages those concerned to remove themselves from registries, include refusals in legal documents, and carry cards indicating their wishes.

A Call for Ethical Alternatives

Dr. Klessig supports living donation—where both donor and recipient survive—as an ethical and life-saving option. She also believes in investing in artificial organ technology, like the fully implantable artificial heart now in clinical trials.

What she opposes is the removal of organs from people who are biologically alive but labeled dead through flawed and inconsistent criteria.