Confirmation of brainstem death

Cameron, E John; Bellini, Antonio; Damian, Maxwell S.; Breen, David P

doi:10.1136/practneurol-2015-001297

Cited by 9 publications

(6 citation statements)

References 18 publications

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“…Not all confounding factors are accurately recognized in clinical practice. The most common confounding factors are persistent pharmacological effects of sedatives, opioids, anesthetic drugs, neuromuscular-blocking drugs, or metabolic derangements (Cameron et al 2016 ). Pharmacological effects of heavy sedation as well as thermoregulatory and metabolic derangements were potential confounding factors present in Child A ( Re: A (A Child) 2015 , para 5 and para 16).…”

Section: A Medico-ethical Critiquementioning

confidence: 99%

“…Firstly, the code of practice assumes that the diagnosis of brainstem death is equivalent to clinical death because of an irreversible loss of the capacity for consciousness. Many clinicians in the UK have presented this assumption in medical literature as a confirmed fact when there is no supportive neuroscientific evidence (Cameron et al 2016 ). As previously highlighted, Mr. Justice Hayden was told “that no patient has ever regained consciousness or awareness following brain stem death” ( Re: A (A Child) 2015 , para 11).…”

Section: A Medico-ethical Critiquementioning

confidence: 99%

“…There is no uniform neurological standard in death determination because of the variability in practices and perceptions of the global medical community about brain death (Wahlster et al 2015 ). The neurological determination of death varies among countries with regard to the use of whole brain criteria or brainstem criteria, and the mandatory performance of confirmatory tests (Ding et al 2015 ; Citerio and Murphy 2015 ; Chua et al 2015 ; Varelas 2016 ; Cameron et al 2016 ). Confirmatory tests include neuroimaging of cerebral blood flow and electrophysiological studies of the cerebral hemispheres and the brainstem.…”

Section: Introductionmentioning

confidence: 99%

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Re A (A Child) and the United Kingdom Code of Practice for the Diagnosis and Confirmation of Death: Should a Secular Construct of Death Override Religious Values in a Pluralistic Society?

Choong

Rady

2016

HEC Forum

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The determination of death by neurological criteria remains controversial scientifically, culturally, and legally, worldwide. In the United Kingdom, although the determination of death by neurological criteria is not legally codified, the Code of Practice of the Academy of Medical Royal Colleges is customarily used for neurological (brainstem) death determination and treatment withdrawal. Unlike some states in the US, however, there are no provisions under the law requiring accommodation of and respect for residents' religious rights and commitments when secular conceptions of death based on medical codes and practices conflict with a traditional concept well-grounded in religious and cultural values and practices. In this article, we analyse the medical, ethical, and legal issues that were generated by the recent judgement of the High Court of England and Wales in Re: A (A Child) [2015] EWHC 443 (Fam). Mechanical ventilation was withdrawn in this case despite parental religious objection to a determination of death based on the code of practice. We outline contemporary evidence that has refuted the reliability of tests of brainstem function to ascertain the two conjunctive clinical criteria for the determination of death that are stipulated in the code of practice: irreversible loss of capacity for consciousness and somatic integration of bodily biological functions. We argue that: (1) the tests of brainstem function were not properly undertaken in this case; (2) the two conjunctive clinical criteria set forth in the code of practice cannot be reliably confirmed by these tests in any event; and (3) absent authentication of the clinical criteria of death, the code of practice (in fact, although implicitly rather than explicitly) wrongly invokes a secular definition of death based on the loss of personhood. Consequently, the moral obligation of a pluralistic society to honor and respect diverse religious convictions to the greatest extent possible is being violated. Re A (A Child) is contrasted with the US case of Jahi McMath in which the court accommodated parental religious objection to the determination of neurological death codified in the Uniform Determination of Death Act. We conclude that the legal system in the United Kingdom should not favour a secular definition of death over a definition of death that is respectful of religious values about the inviolability and sanctity of life. We recommend the legal recognition of religious accommodation in death determination to facilitate cultural sensitivity and compassionate care to patients and families in a pluralistic society.Electronic supplementary materialThe online version of this article (doi:10.1007/s10730-016-9307-y) contains supplementary material, which is available to authorized users.

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Section: A Medico-ethical Critiquementioning

confidence: 99%

Section: A Medico-ethical Critiquementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Re A (A Child) and the United Kingdom Code of Practice for the Diagnosis and Confirmation of Death: Should a Secular Construct of Death Override Religious Values in a Pluralistic Society?

Choong

Rady

2016

HEC Forum

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“…Este concepto, en lugar de requerir la pérdida de todas las funciones cerebrales, se enfoca en la pérdida irreversible de sólo dos funciones críticas: conciencia y respiración espontánea (3) . Cameron y colaboradores jerarquizan la exploración clínica del TE al señalar que: "…La ausencia de flujo sanguíneo al tronco encefálico implica la muerte del mismo, aunque su presencia no impide el diagnósti-co…" (12) . La evidencia de la pérdida irreversible de la actividad del TE es suficiente para el concepto de MT (12,13) .…”

Section: Nuestra Opiniónunclassified

Dos enfoques conocidos para la determinacion de muerte neurológica del adulto: propuesta de un concepto unificado

2022

RMY

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Cuanto más progreso en el conocimiento de la injuria encefálica aguda (IEA) irreversible y su potencial evolución a la muerte encefálica (ME), existirán más posibilidades de captación de donantes, con la consiguiente disminución de las listas de espera. A nuestro criterio, el médico intensivista deberá tener presente tal posibilidad cuando se enfrenta a víctimas de neuroinjuria independientemente de su etiología. Además, resulta imprescindible que conozca la fisiopatología del síndrome de ME y los pasos a seguir para la realización de un examen neurológico completo, exhaustivo y riguroso que lo confirme. Al día de hoy, existen dos conceptos de muerte según criterios neurológicos: muerte encefálica total' (MET) y muerte de troncoencéfalo (MT). Si bien ambas definiciones son aceptadas por la comunidad médica mundial, algunos países adoptan una u otra, recibiendo el marco legal correspondiente que lo avale. Debatiremos ambos conceptos, con la intención de intentar generar un concepto unificado y consensuado de ME.

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“…Even within the same country, e.g., the USA, guidelines and practices may vary according to geography (32). Also, while in most countries a patient is declared brain dead when clinical examination and confirmatory tests (if required) indicate irreversible loss of activity of the entire brain ("whole brain death"), the UK and India, by contrast, have implemented the concept of brainstem death, i.e., evidence of the irreversible loss of brainstem activity is sufficient (33,34).…”

Section: Brain Death Criteriamentioning

confidence: 99%

The Neurology of Death and the Dying Brain: A Pictorial Essay

Kondziella

2020

Front. Neurol.

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As neurologists earn their living with the preservation and restoration of brain function, they are also well-positioned to address the science behind the transition from life to death. This essay in pictures highlights areas of neurological expertise needed for brain death determination; shows pitfalls to avoid during the clinical examination and interpretation of confirmatory laboratory tests in brain death protocols; illustrates the great variability of brain death legislations around the world; discusses arguments for the implementation of donation after circulatory death (DCD); points to unresolved questions related to DCD and the time between cardiac standstill and organ procurement ("hands-off period"); provides an overview of the epidemiology and semiology of near-death experiences, including their importance for religion, literature, and the visual arts; suggests biological mechanisms for near-death experiences such as dysfunction of temporoparietal cortex, N-methyl-D-aspartate receptor antagonism, migraine aura, and rapid eye movement sleep; hypothesizes that thanatosis (aka. death-feigning, a common behavioral trait in the animal kingdom) represents the evolutionary origin of neardeath experiences; and speculates about the future implications of recent attempts of brain resuscitation in an animal model. The aim is to provide the reader with a thorough understanding that the boundaries within the neurology of death and the dying brain are being pushed just like everywhere else in the clinical neurosciences.

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Confirmation of brainstem death

Cited by 9 publications

References 18 publications

Re A (A Child) and the United Kingdom Code of Practice for the Diagnosis and Confirmation of Death: Should a Secular Construct of Death Override Religious Values in a Pluralistic Society?

Re A (A Child) and the United Kingdom Code of Practice for the Diagnosis and Confirmation of Death: Should a Secular Construct of Death Override Religious Values in a Pluralistic Society?

Dos enfoques conocidos para la determinacion de muerte neurológica del adulto: propuesta de un concepto unificado

The Neurology of Death and the Dying Brain: A Pictorial Essay

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