An interdisciplinary response to contemporary concerns about brain death determination

Abstract

In response to a number of recent lawsuits related to brain death determination, the American Academy of Neurology Ethics, Law, and Humanities Committee convened a multisociety quality improvement summit in October 2016 to address, and potentially correct, aspects of brain death determination within the purview of medical practice that may have contributed to these lawsuits. This article, which has been endorsed by multiple societies that are stakeholders in brain death determination, summarizes the discussion at this summit, wherein we (1) reaffirmed the validity of determination of death by neurologic criteria and the use of the American Academy of Neurology practice guideline to determine brain death in adults; (2) discussed the development of systems to ensure that brain death determination is consistent and accurate; (3) reviewed strategies to respond to objections to determination of death by neurologic criteria; and (4) outlined goals to improve public trust in brain death determination.

Apnea Threshold in Pediatric Brain Death: A Case with Variable Results Across Serial Examinations

“…Thus, clinical death determination often precedes total necrosis of the heart or brain. 11,13,23 Neuropathological specimens support this as some brain-dead patients have retained groups of functioning neurons and glia. 13,23 Some brain-dead patients retain neuroendocrine functions, and a small proportion retains some electrical activity on EEG, or blood flow on cerebral angiography.…”

“…families and can erode the trust relationship with the medical team. [11][12][13] Because this report describes a pediatric patient in the United States, it is important to note the guidelines for determining brain death in pediatric and adult patients have many similarities, but also significant differences. 2,3 ►Table 1 compares these guidelines.…”

Truly Reconciling the Case of Jahi McMath

“…Regarding the maintenance of public confidence in the diagnosis of BD for the sake of transplantation [26], that goal should be accomplished by making the diagnosis worthy of confidence. Counterexamples to the claimed infallibility of the Guidelines should be taken seriously and learned from.…”

Brain death, the determination of brain death, and member guidance for brain death accommodation requests

“…17 This position is a byproduct of the goals identified by a brain death summit, sponsored by the AAN in the autumn of 2016, and the Brain Death Working Group spawned by that meeting. 19…”