Brain Death Revisited: The Case for a National Standard

Choi, Eun‐Kyoung; Fredland, Valita; Zachodni, Carla; Lammers, J. Eugene; Bledsoe, Patricia; Helft, Paul R.

doi:10.1111/j.1748-720x.2008.00340.x

Cited by 21 publications

(9 citation statements)

References 23 publications

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“…While each institution and state may have specific guidelines for the determination of brain death in infants and children, we should work with national medical societies to achieve a uniform approach to declaring death that can be incorporated in all hospital policies. 75 This will help eliminate confusion among medical personnel thereby fostering further trust from the community of patients and families that we serve.…”

Section: Future Directionsmentioning

confidence: 99%

Guidelines for the Determination of Brain Death in Infants and Children: An Update of the 1987 Task Force Recommendations

Nakagawa¹,

Ashwal²,

Mathur³

et al. 2011

Pediatrics

187

120

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OBJECTIVE: To review and revise the 1987 pediatric brain death guidelines. METHODS: Relevant literature was reviewed. Recommendations were developed using the GRADE system. CONCLUSIONS AND RECOMMENDATIONS: (1) Determination of brain death in term newborns, infants and children is a clinical diagnosis based on the absence of neurologic function with a known irreversible cause of coma. Because of insufficient data in the literature, recommendations for preterm infants less than 37 weeks gestational age are not included in this guideline.

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Section: Future Directionsmentioning

confidence: 99%

Guidelines for the Determination of Brain Death in Infants and Children: An Update of the 1987 Task Force Recommendations

Nakagawa¹,

Ashwal²,

Mathur³

et al. 2011

Pediatrics

187

120

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“…This statutory inconsistency, along with the varying state and institutional standards for diagnosing brain death, has led to renewed calls for a uniform national standard. 16…”

Section: Legal Perspectivementioning

confidence: 99%

“…This statutory inconsistency, along with the varying state and institutional standards for diagnosing brain death, has led to renewed calls for a uniform national standard. 16 In the case presented, SP's physicians have made a medical determination of brain death. If that conclusion has been reached in conformance with prevailing state law, SP is dead.…”

Section: Voltairementioning

confidence: 99%

Life Support After Brain Death

Baumrucker

Hutchinson

Stolick

et al. 2014

Am J Hosp Palliat Care

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SP is a 52-year-old male who had an out-of-hospital cardiac arrest 10 days ago. He was found by his wife unconscious on the floor after an unknown amount of time. She provided cardiopulmonary resuscitation for 15 minutes until emergency medical services arrived. The initial rhythm was fine ventricular fibrillation and a stable rhythm with pulse was obtained after 10 minutes of advanced cardiac life support. He was transported to the local tertiary care hospital and hypothermia was provided. After rewarming for 24 hours, SP had a Glasgow Coma Scale of 3 (totally unresponsive). Despite a prolonged discussion of prognosis in anoxic brain injury, the patient's wife and children advocated aggressive treatment stating ''we're expecting a miracle to happen.'' An electroencephalogram (EEG) done yesterday showed no significant brain activity. Today, the medical team performed an apnea test on SP, which showed a 20-mm Hg increase in PCO 2 , supporting a diagnosis of brain death. A follow-up radionuclide cerebral flow study confirmed the diagnosis of brain death. The palliative medicine team discussed the results of the brain death determination at length with the family, who threatened to sue the hospital if SP was taken off life support, arguing that people recover from comas and that removing him from life support would be ''tantamount to murder.'' Risk management recommended deferring any withdrawal of medical treatment. Multiple discussions with the family had the same result and an ethics consult was requested.

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“…Developing uniform national practice guidelines for circulatory-respiratory death determinations in DCD is desirable for the same reason that they have been advocated for brain death determinations (Choi et al, 2008). Guidelines should be based on a rigorous analysis of death accompanied by prudential societal considerations.…”

Section: Future Directionsmentioning

confidence: 99%

How the Distinction between "Irreversible" and "Permanent" Illuminates Circulatory-Respiratory Death Determination

Bernat

2010

Journal of Medicine and Philosophy

112

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The distinction between the "permanent" (will not reverse) and "irreversible" (cannot reverse) cessation of functions is critical to understand the meaning of a determination of death using circulatory-respiratory tests. Physicians determining death test only for the permanent cessation of circulation and respiration because they know that irreversible cessation follows rapidly and inevitably once circulation no longer will restore itself spontaneously and will not be restored medically. Although most statutes of death stipulate irreversible cessation of circulatory and respiratory functions, the accepted medical standard is their permanent cessation because permanence is a perfect surrogate indicator for irreversibility, and using it permits a more timely declaration. Therefore, patients properly declared dead in donation after circulatory death (DCD) protocols satisfy the requirements of death statutes and do not violate the dead donor rule. The acronym DCD should represent organ "donation after circulatory death" to clarify that the death standard is the permanent cessation of circulation, not heartbeat. Heart donation in DCD does not retroactively negate the donor's death determination because circulation has ceased permanently.

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Brain Death Revisited: The Case for a National Standard

Cited by 21 publications

References 23 publications

Guidelines for the Determination of Brain Death in Infants and Children: An Update of the 1987 Task Force Recommendations

Guidelines for the Determination of Brain Death in Infants and Children: An Update of the 1987 Task Force Recommendations

Life Support After Brain Death

How the Distinction between "Irreversible" and "Permanent" Illuminates Circulatory-Respiratory Death Determination

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