State of irreversible destruction of the brain. Before the invention of life-support systems, brain death always led quickly to death of the body. Ethical considerations are crucial to defining criteria for brain death, which in most countries must be met before efforts to extend life may be ended. Such criteria include deep coma with a known cause, absence of any brainstem functions (e.g., spontaneous respiration, pupil reactions, gag and cough reflexes), and exclusion of hypothermia, drugs, and poison as causes. electroencephalography is useful but not essential in determining brain death. Organ donors must be declared brain-dead before their organs may be removed for transplant. The question of when life support can legally be ended has been the subject of numerous court cases.