The declaration of brain death (BD), or death by neurological criteria (DNC), is medically and legally accepted throughout much of the world. However, inconsistencies in national and international policies have prompted efforts to harmonize practice and central concepts, both between and within countries. The World Brain Death Project was published in 2020, followed by notable revisions to the Canadian and US guidelines in 2023. The mission of these initiatives was to ensure accurate and conservative determination of BD/DNC, as false-positive determinations could have major negative implications for the medical field and the public’s trust in our ability to accurately declare death. In this Review, we review the changes that were introduced in the 2023 US BD/DNC guidelines and consider how these guidelines compare with those formulated in Canada and elsewhere in the world. We address controversies in BD/DNC determination, including neuroendocrine function, consent and accommodation of objections, summarize the legal status of BD/DNC internationally and discuss areas for further BD/DNC research.

脑死亡（BD）或神经学标准死亡（DNC）的宣告在世界大部分地区在医学上和法律上都被接受。然而，国家和国际政策的不一致促使人们努力协调国家之间和国家内部的做法和核心概念。世界脑死亡项目于 2020 年发布，随后于 2023 年对加拿大和美国的指南进行了重大修订。这些举措的使命是确保 BD/DNC 的确定准确且保守，因为假阳性确定可能会产生重大负面影响为了医学界和公众对我们准确宣告死亡的能力的信任。在本次审查中，我们审查了 2023 年美国 BD/DNC 指南中引入的变更，并考虑了这些指南与加拿大和世界其他地方制定的指南的比较。我们讨论了 BD/DNC 确定中的争议，包括神经内分泌功能、同意和异议的接受，总结了 BD/DNC 在国际上的法律地位，并讨论了 BD/DNC 进一步研究的领域。