Medicolegal Complications of Apnoea Testing for Determination of Brain Death

Lewis, Ariane; Greer, David M.

doi:10.1007/s11673-018-9863-8

Cited by 14 publications

(12 citation statements)

References 62 publications

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“…For these reasons, though apnea test should be performed last after the rest of the evaluation is completed, so hypercarbia does not confound the other cranial nerve exams [7], or, if two BD exams are planned, the apnea test should be performed with the second exam [86]. The currently practiced standard is that decision-making about performance of apnea testing should not be adjudicated in a courtroom and should not be left up to families, but should be the responsibility of clinicians [94][95][96]. Moreover, a survey of adult neurologists demonstrated that consent is not routinely obtained prior to AT [97,98].…”

Section: Legal Considerations Of Atmentioning

confidence: 99%

Apnea Testing for the Determination of Brain Death: A Systematic Scoping Review

2020

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Apnea is one of the three cardinal findings in brain death (BD). Apnea testing (AT) is physiologically and practically complex. We sought to review described modifications of AT, safety and complication rates, monitoring techniques, performance of AT on extracorporeal membrane oxygenation (ECMO), and other relevant considerations regarding AT. We conducted a systematic scoping review to answer these questions by searching the literature on AT in English language available in PubMed or EMBASE since 1980. Pediatric or animal studies were excluded. A total of 87 articles matched our inclusion criteria and were qualitatively synthesized in this review. A large body of the literature on AT since its inception addresses a variety of modifications, monitoring techniques, complication rates, ways to perform AT on ECMO, and other considerations such as variability in protocols, lack of uniform awareness, and legal considerations. Only some modifications are widely used, especially methods to maintain oxygenation, and most are not standardized or endorsed by brain death guidelines. Future updates to AT protocols and strive for unification of such protocols are desirable.

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Section: Legal Considerations Of Atmentioning

confidence: 99%

Apnea Testing for the Determination of Brain Death: A Systematic Scoping Review

2020

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“…4,5 While most of the debate has been conducted in the scientific and ethical literature, in recent years there have been several international legal challenges to its validity in individual cases. 6,7 Although it is claimed that the concept of BD is 'certain', 8 in the lay media there appears to be significant uncertainty. Media reports frequently highlight cases of patients apparently diagnosed as 'brain dead' who recover.…”

Section: Introductionmentioning

confidence: 99%

“…Over the decades, there have been numerous publications on these matters 4,5 . While most of the debate has been conducted in the scientific and ethical literature, in recent years there have been several international legal challenges to its validity in individual cases 6,7 …”

Section: Introductionmentioning

confidence: 99%

Death, dying and donation: community perceptions of brain death and their relationship to decisions regarding withdrawal of vital organ support and organ donation

Skowronski

O’Leary

Critchley

et al. 2020

Internal Medicine Journal

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Despite brain death (BD) being established as a definition of death for over 50 years, the concept remains controversial. Little is known about public perception of death determination in decision-making about withdrawal of organ support and organ donation (OD), and the importance of the 'Dead Donor Rule' (DDR). We examined perceptions about death in a BD patient and their relationship to decisions about withdrawal of vital organ support, OD and the DDR, using an online survey of 1017 Australian adults. A BD patient scenario was presented, followed by a series of questions. Statistically significant differences in responses were determined using repeated measures analyses of variance and t tests. Seven hundred and fourteen respondents (70.2%) agreed that a hypothetical BD patient was dead. Those disagreeing most commonly cited the presence of heartbeat and breathing. Seven hundred and seventy (75.7%) favoured removal of 'life support', including 136 (13.3%) who had not agreed the patient was dead. Support for OD was high, but most favoured organ removal only after heartbeat and breathing had ceased. Where OD was in keeping with the patient's known wishes, 464 (45.6%) agreed that organs could be removed even if this caused death. Forty-one (20%) of those who had indicated they considered the patient was not dead agreed to organ removal even if it caused death. Australian public views on BD, withdrawal of 'life support' and OD are complex. Emphasis on prognosis and the impact of significant brain injury may be more appropriate in these situations, rather than focussing on death determination and upholding the DDR.

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“…This would lead to unnecessary continuation of ventilatory support (no guidelines are in place on ventilator discontinuation in cases of refusal to organ donation), triage and engagement of human resources in maintaining a brainstem dead patient, and compromise moral integrity of treating doctor. 13…”

Section: Introductionmentioning

confidence: 99%

Redefining Death: Urgent Need to Evolve toward a Homogeneous Definition of Death in India

Vadi

Shroff

2019

Indian Journal of Critical Care Medicine

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The interdependent circulatory-respiratory criteria and brainstem criteria are used to define death. Continuing life-support in brainstem dead patients is a legal conundrum for the health-care professionals and an ethical worry for the society at large. There is an urgent need to revisit this subject to evolve a more uniform definition of death irrespective of the circumstances. A compelling take-home message from this discussion is to spread awareness about brainstem death amongst healthcare professionals How to cite this article Vadi S, Shroff S. Redefining Death: Urgent Need to Evolve Toward a Homogeneous Definition of Death in India. Indian J Crit Care Med 2019;23(8):368–370.

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Medicolegal Complications of Apnoea Testing for Determination of Brain Death

Cited by 14 publications

References 62 publications

Apnea Testing for the Determination of Brain Death: A Systematic Scoping Review

Apnea Testing for the Determination of Brain Death: A Systematic Scoping Review

Death, dying and donation: community perceptions of brain death and their relationship to decisions regarding withdrawal of vital organ support and organ donation

Redefining Death: Urgent Need to Evolve toward a Homogeneous Definition of Death in India

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