Formal Training Improves Resident Understanding and Communication Regarding Brain Death/Death by Neurologic Criteria

2021 ◽  
Author(s):  
Iman N. Afif ◽  
Amy J. Goldberg ◽  
Huaqing Zhao ◽  
Gweneth D. O'Shaughnessy ◽  
Sarah M. Kling ◽  
...  
Keyword(s):  
Brain Death ◽  
Formal Training ◽  
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.

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

Metabolic values precluding clinical death by neurologic Criteria/Brain death: Survey of neurocritical care society physicians

2021 ◽  
Vol 88 ◽  
pp. 16-21
Author(s):  
David P. Lerner ◽  
Ribal Bassil ◽  
Aleksey Tadevosyan ◽  
Anil Ramineni ◽  
Joseph D. Burns ◽  
...  
Keyword(s):  
Brain Death ◽  
Neurocritical Care ◽  
Clinical Death ◽  
Care Society ◽  
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.

scholarly journals The Death Debate: Penumbra Conundrum

2018 ◽  
Vol 35 (12) ◽  
pp. 1473-1476
Author(s):  
Robert F. Johnson
Keyword(s):  
Brain Death ◽  
Nutritional Support ◽  
Legal Issues ◽  
Clinical Implications ◽  
Neurologic Injury ◽  
Ethical And Legal Issues ◽  
Death By Neurologic Criteria ◽  
Ischemic Encephalopathy ◽  
Over Time ◽  
Testing Criteria

Determination and declaration of death by neurologic criteria, brain death, is an established and legally accepted clinical practice with profound implications. Concerns regarding the accuracy of this diagnosis raise important clinical, ethical, and legal issues. A recent magazine article highlights these concerns by describing a poignant example of a patient meeting accepted clinical and ancillary testing criteria for brain death in the setting of post cardiac arrest hypoxic ischemic encephalopathy (CA-HIE). With continuation of ventilatory and nutritional support, this patient not only survived but over time demonstrated findings that were no longer consistent with brain death. Offered here is a review of the course of events described in the article, an overview of the variable clinical implications of CA-HIE and their relationship to the diagnosis of brain death, a proposed pathophysiologic correlation, and recommendations for palliative clinicians providing consultation with regard to goals of care and intervention options in cases of CA-HIE with severe neurologic injury.

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 Organ Donation and Declaration of Death: Combined Neurologic and Cardiopulmonary Standards

2019 ◽  
Vol 86 (4) ◽  
pp. 285-296
Author(s):  
Stephen E. Doran ◽  
Joseph M. Vukov
Keyword(s):  
Brain Death ◽  
Organ Donation ◽  
Conflict Of Interest ◽  
Life Support ◽  
Organ Procurement ◽  
Organ Donors ◽  
Neurologic Injury ◽  
Brain Dead ◽  
Moral Certainty ◽  
Death By Neurologic Criteria

Prolonged survival after the declaration of death by neurologic criteria creates ambiguity regarding the validity of this methodology. This ambiguity has perpetuated the debate among secular and nondissenting Catholic authors who question whether the neurologic standards are sufficient for the declaration of death of organ donors. Cardiopulmonary criteria are being increasingly used for organ donors who do not meet brain death standards. However, cardiopulmonary criteria are plagued by conflict of interest issues, arbitrary standards for candidacy, and the lack of standardized protocols for organ procurement. Combining the neurological and cardiopulmonary standards into a single protocol would mitigate the weaknesses of both and provide greater biologic and moral certainty that a donor of unpaired vital organs is indeed dead. Summary: Before a person’s organs can be used for transplantation, he or she must be declared “brain-dead.” However, sometimes when someone is declared brain-dead, that person can be maintained on life-support for days or even weeks. This creates some confusion about whether the person has truly died. For patients who have a severe neurologic injury but are not brain-dead, organ donation can also occur after his or her heart stops beating. However, this protocol is more ambiguous and lacks standardized protocols. We propose that before a person can donate organs, he or she must first be declared brain-dead, and then his or her heart must irreversibly stop beating before organs are taken.

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