Determination of Brain Death/Death by Neurologic Criteria

JAMA ◽  
2020 ◽  
Vol 324 (11) ◽  
pp. 1078 ◽  
Author(s):  
David M. Greer ◽  
Sam D. Shemie ◽  
Ariane Lewis ◽  
Sylvia Torrance ◽  
Panayiotis Varelas ◽  
...  
Keyword(s):  
Brain Death ◽  
Death By Neurologic Criteria

scholarly journals An interdisciplinary response to contemporary concerns about brain death determination

Neurology ◽  
2018 ◽  
Vol 90 (9) ◽  
pp. 423-426 ◽  
Author(s):  
Ariane Lewis ◽  
James L. Bernat ◽  
Sandralee Blosser ◽  
Richard J. Bonnie ◽  
Leon G. Epstein ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Brain Death ◽  
American Academy ◽  
Determination Of Death ◽  
Brain Death Determination ◽  
Death By Neurologic Criteria ◽  
Law And Humanities ◽  
American Academy Of Neurology ◽  
Death Determination

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.

Determination of death by neurologic criteria around the world

Neurology ◽  
2020 ◽  
Vol 95 (3) ◽  
pp. e299-e309 ◽  
Author(s):  
Ariane Lewis ◽  
Azza Bakkar ◽  
Elana Kreiger-Benson ◽  
Andrew Kumpfbeck ◽  
Jordan Liebman ◽  
...  
Keyword(s):  
Brain Death ◽  
Drug Clearance ◽  
Noxious Stimulation ◽  
Pupillary Reflex ◽  
Cough Reflex ◽  
Medical Standards ◽  
The World ◽  
The Face ◽  
Death By Neurologic Criteria

ObjectiveTo identify similarities and differences in protocols on determination of brain death/death by neurologic criteria (BD/DNC) around the world.MethodsWe collected and reviewed official national BD/DNC protocols from contacts around the world between January 2018 and April 2019.ResultsWe communicated with contacts in 136 countries and found that 83 (61% of countries with contacts identified, 42% of the world) had BD/DNC protocols, 78 of which were unique. Protocols addressed the following prerequisites and provided differing instructions: drug clearance (64, 82%), temperature (61, 78%), laboratory values (56, 72%), observation period (37, 47%), and blood pressure (34, 44%). Protocols did not consistently identify the same components for the clinical examination of brain death; 70 (90%) included coma, 70 (90%) included the pupillary reflex, 68 (87%) included the corneal reflex, 67 (86%) included the oculovestibular reflex, 64 (82%) included the gag reflex, 62 (79%) included the cough reflex, 58 (74%) included the oculocephalic reflex, 37 (47%) included noxious stimulation to the face, and 22 (28%) included noxious stimulation to the limbs. Apnea testing was mentioned in 71 (91%) protocols; there was variability in the technique and target across protocols. Ancillary testing was included as a requirement for all determinations of BD/DNC in 22 (28%) protocols.ConclusionsThere is considerable variability in BD/DNC determination protocols around the world. Medical standards for death should be the same everywhere. We recommend that a worldwide consensus be reached on the minimum standards for BD/DNC.

Determination of Death by Neurologic Criteria in the United States: The Case for Revising the Uniform Determination of Death Act

2019 ◽  
Vol 47 (S4) ◽  
pp. 9-24 ◽  
Author(s):  
Ariane Lewis ◽  
Richard J. Bonnie ◽  
Thaddeus Pope ◽  
Leon G. Epstein ◽  
David M. Greer ◽  
...  
Keyword(s):  
United States ◽  
Clinical Practice ◽  
Brain Death ◽  
The United States ◽  
Determination Of Death ◽  
State Laws ◽  
Medical Standards ◽  
Key Issues ◽  
Death By Neurologic Criteria

Although death by neurologic criteria (brain death) is legally recognized throughout the United States, state laws and clinical practice vary concerning three key issues: (1) the medical standards used to determine death by neurologic criteria, (2) management of family objections before determination of death by neurologic criteria, and (3) management of religious objections to declaration of death by neurologic criteria. The American Academy of Neurology and other medical stakeholder organizations involved in the determination of death by neurologic criteria have undertaken concerted action to address variation in clinical practice in order to ensure the integrity of brain death determination. To complement this effort, state policymakers must revise legislation on the use of neurologic criteria to declare death. We review the legal history and current laws regarding neurologic criteria to declare death and offer proposed revisions to the Uniform Determination of Death Act (UDDA) and the rationale for these recommendations.

Contentious Ethical and Legal Aspects of Determination of Brain Death

2018 ◽  
Vol 38 (05) ◽  
pp. 576-582 ◽  
Author(s):  
Ariane Lewis
Keyword(s):  
United States ◽  
Brain Death ◽  
The United States ◽  
Legal Aspects ◽  
Determination Of Death ◽  
The World ◽  
Death By Neurologic Criteria ◽  
Role Of Religion

AbstractAlthough the concept of death by neurologic criteria is accepted throughout much of the world and death can legally be determined by neurologic criteria throughout the United States, the process is fraught with contentious ethical and legal controversies. I explore historic and contemporary ethical and legal disputes about determination of death by neurologic criteria including the need for consent from patients' surrogates prior to determination of death, the role of religion in determination of death, management of objections to determination of death by neurologic criteria, the approach to patients who are dead by neurologic criteria but are pregnant, and gamete retrieval after determination of death.

scholarly journals More about the Determination of Death by Neurologic Criteria

2020 ◽  
Author(s):  
Calixto Machado
Keyword(s):  
Brain Death ◽  
The United States ◽  
Determination Of Death ◽  
Her Family ◽  
Legal Foundation ◽  
The Us ◽  
Jahi Mcmath ◽  
Death By Neurologic Criteria ◽  
Death Cases

Lewis et al. published an important and timely necessary article about the determination of death by neurological criteria, revising the Uniform Determination of Death.The acceptance of brain death (BD) has been progressively accepted beginning at the late 1950s. Nonetheless, contentious brain-death cases have recently raised new controversies about the diagnosis of BD, such as the Jahi McMath case, extensively covered by the US and international press. Jahi McMath meant a terrible tragedy for her and her family. But further than this gloomy story, the case has also raised confusion and challenging qualms about a fundamental query: how we confirm whether a person is dead or alive? Since 1981, the Uniform Determination of Death Act (UDDA) has served as the legal foundation for the medical practice of determining death. But, although death by neurologic criteria is considered legal death throughout the United States, several recent lawsuits have quizzed the rightfulness the authority of the UDDA to declare death by neurological criteria. This issue explains the importance of Lewis’s et al. paper. In this article I want to present the historical procedure for issuing a law in Cuba for the determination and certification of death. Of course, it is impossible to compare our country with USA. Cuba is a small and developing country, in which a law encompasses a national scenery, in contrast with USA, a multistate nation.

scholarly journals Determination of Brain Death/Death by Neurologic Criteria in Countries in Asia and the Pacific

2020 ◽  
Vol 16 (3) ◽  
pp. 480
Author(s):  
Ariane Lewis ◽  
Jordan Liebman ◽  
Azza Bakkar ◽  
Elana Kreiger-Benson ◽  
Andrew Kumpfbeck ◽  
...  
Keyword(s):  
Brain Death ◽  
The Pacific ◽  
Death By Neurologic Criteria

Barriers to the Use of Neurologic Criteria to Declare Death in Africa

2021 ◽  
pp. 104990912110069
Author(s):  
Ariane Lewis ◽  
Andrew Kumpfbeck ◽  
Jordan Liebman ◽  
Sam D. Shemie ◽  
Gene Sung ◽  
...  
Keyword(s):  
Brain Death ◽  
Legal Framework ◽  
Developing Regions ◽  
Healthcare Facilities ◽  
Life And Death ◽  
The World ◽  
Religious Perspectives ◽  
World Brain ◽  
The Creation ◽  
Death By Neurologic Criteria

There are varying medical, legal, social, religious and philosophical perspectives about the distinction between life and death. Death can be declared using cardiopulmonary or neurologic criteria throughout much of the world. After solicitation of brain death/death by neurologic criteria (BD/DNC) protocols from contacts around the world, we found that the percentage of countries with BD/DNC protocols is much lower in Africa than other developing regions. We performed an informal review of the literature to identify barriers to declaration of BD/DNC in Africa. We found that there are numerous medical, legal, social and religious barriers to the creation of BD/DNC protocols in Africa including 1) limited number of healthcare facilities, critical care resources and clinicians with relevant expertise; 2) absence of a political and legal framework codifying death; and 3) cultural and religious perspectives that present ideological conflict with the idea of BD/DNC, in particular, and between traditional and Western medicine, in general. Because there are a number of unique barriers to the creation of BD/DNC protocols in Africa, it remains to be seen how the World Brain Death Project, which is intended to create minimum standards for BD/DNC around the world, will impact BD/DNC determination in Africa.

Xenon computed tomography measuring cerebral blood flow in the determination of brain death in children

1989 ◽  
Vol 25 (6) ◽  
pp. 539-546 ◽  
Author(s):  
Stephen Ashwal ◽  
Sanford Schneider ◽  
Joseph Thompson
Keyword(s):  
Computed Tomography ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Brain Death ◽  
Xenon Computed Tomography
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