section_path: Diagnosis/Problems of definition/Problems in medical practice
section_name: Problems in medical practice
paragraph_text: Problems in medical practice
  
  Aside from the issue of support of or dispute against brain death, there is another inherent problem in this categorical definition: the variability of its application in medical practice. In 1995, the American Academy of Neurology (AAN) established the criteria that became the medical standard for diagnosing neurologic death. At that time, three clinical features had to be satisfied to determine "irreversible cessation" of the total brain, including coma with clear etiology, cessation of breathing, and lack of brainstem reflexes. These criteria were updated again, most recently in 2010, but substantial discrepancies remain across hospitals and medical specialties.