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.

Brain Death — Too Flawed to Endure, Too Ingrained to Abandon

2007 ◽  
Vol 35 (2) ◽  
pp. 273-281 ◽  
Author(s):  
Robert D. Truog
Keyword(s):  
United States ◽  
Brain Death ◽  
The United States ◽  
Determination Of Death ◽  
Medical Standards ◽  
The World ◽  
The Brain ◽  
Irreversible Cessation ◽  
Made In

The concept of brain death was recently described as being “at once well settled and persistently unresolved.” Every day, in the United States and around the world, physicians diagnose patients as brain dead, and then proceed to transplant organs from these patients into others in need. Yet as well settled as this practice has become, brain death continues to be the focus of controversy, with two journals in bioethics dedicating major sections to the topic within the last two years.By way of background, the Uniform Determination of Death Act states that “[a]n individual who has sustained either: (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead. A determination of death must be made in accordance with accepted medical standards.” In other words, death can be defined by either cardiorespiratory or neurological criteria, with “brain death” representing the loss of all brain function. This standard, or closely related variants, has become the accepted approach throughout the United States and in many parts of the world.

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.

Guidelines for the Determination of Brain Death in Children

PEDIATRICS ◽  
1987 ◽  
Vol 80 (2) ◽  
pp. 298-300 ◽  
Keyword(s):  
Young Children ◽  
Brain Death ◽  
Task Force ◽  
Determination Of Death ◽  
State Laws ◽  
Proximate Cause ◽  
Medical Standards ◽  
Bar Association ◽  
Irreversible Cessation

Most states now have laws on brain death, and the American Medical Association, the American Bar Association, the National Conference of Commissioners on Uniform State Laws, the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, and this Task Force have all endorsed the following language regarding the determination of death: An individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions or (2) irreversible cessation of all functions of the entire brain, including the brainstem, is dead. A determination of death must be made in accordance with accepted medical standards. There are no unique legal issues in determining brain death in children as compared with adults. The unique issues are all medical ones and related directly to the more difficult tasks of confirming brain death in young children. Current criteria of brain death avoid application of these standards to "young children." The report of the presidential commission1 outlines criteria valid in children older than 5 years of age. It is generally assumed that the child's brain is more resistant to insults leading to death, although this issue is controversial and lacks convincing clinical documentation.2,3 The criteria outlined are useful in determining brain death in infants and children. In term newborns (> 38 weeks' gestation), the criteria are useful seven days after the neurologic insult. The newborn is difficult to evaluate clinically after perinatal insults. This relates to many factors including difficulties of clinical assessment, determination of proximate cause of coma, and certainty of the validity of laboratory tests.

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.

Overview of the Chromatographic and Mass Spectrometry Analytical Methods for Determination of Lamivudine in Biological Fluids

2019 ◽  
Vol 15 (2) ◽  
pp. 103-108
Author(s):  
Xuwang Chen ◽  
Fanlong Bu ◽  
Rong Li ◽  
Guiyan Yuan ◽  
Yanyan Wang ◽  
...  
Keyword(s):  
United States ◽  
Mass Spectrometry ◽  
Clinical Practice ◽  
Analytical Methods ◽  
Review Paper ◽  
Biological Fluids ◽  
Animal Experiments ◽  
The United States ◽  
Therapeutic Drug

Background: Lamivudine was approved by Food and Drug Administration of the United States for the treatment of both HIV and HBV infection, which has been widely used as monotherapy or a component of combination therapy in clinics in many countries and nationalities. Methods: In this paper, the recent chromatographic and mass spectrometry analytical methods for the determination of lamivudine individually or combination with other drugs simultaneously were presented. These methods were widely applied in pharmacokinetics studies, bioequivalence studies, therapeutic drug monitoring studies, cell and animal experiments. Conclusion: The review paper might provide references for determining lamivudine in biological fluids, the intracorporal process of lamivudine, and the clinical practice by monitoring plasma concentration of lamivudine in the future.

Building a Fence Around Brain Death: The Shielded-Brain Formulation

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012641
Author(s):  
Douglas J Gelb
Keyword(s):  
Clinical Practice ◽  
Brain Death ◽  
Determination Of Death ◽  
Clinical Standards ◽  
History Of ◽  
Uniform Law ◽  
New Formulation ◽  
Law Commission ◽  
Current Practices

The concept of brain death was proposed more than 50 years ago and it has been incorporated in laws and clinical practice, but it remains a source of confusion, debate, and litigation. Because of persistent variability in clinical standards and ongoing controversies regarding policies, the Uniform Law Commission (ULC), which drafted the Uniform Determination of Death Act (UDDA) in 1980, has appointed a committee to study whether the act should be revised. This article reviews the history of the concept of brain death and its philosophical underpinnings, summarizes the objections that have been raised to the prevailing philosophical formulations, and proposes a new formulation that addresses those objections while preserving current practices.

Current Practice Diagnosing Brain Death Is Not Consistent With Legal Statutes Requiring the Absence of All Brain Function

2020 ◽  
pp. 088506662093903
Author(s):  
Michael Nair-Collins ◽  
Franklin G. Miller
Keyword(s):  
Brain Function ◽  
Current Practice ◽  
The United States ◽  
Determination Of Death ◽  
Legal Standard ◽  
Entire Brain ◽  
Hypothalamic Function ◽  
Death By Neurologic Criteria ◽  
Open Question

The legal standard for the determination of death by neurologic criteria in the United States is laid out in the Uniform Determination of Death Act (UDDA), which requires the irreversible cessation of all functions of the entire brain. Most other nations endorse a “whole-brain” standard as well. However, current practice in the determination of death by neurologic criteria is not consistent with this legal standard, because some patients who are diagnosed as brain-dead, in fact retain some brain function, or retain the capacity for the return of some brain function. In response, the American Academy of Neurology published updated guidelines, which assert that hypothalamic function is consistent with the neurological standard enshrined in the UDDA. Others have suggested that it is an open question whether the hypothalamus and pituitary are part of “the entire brain,” as delineated in the UDDA. While we agree that determination of death practices are worthy of continued dialogue and refinement in practice that dialogue must adhere to reasonable standards of logic and scientific accuracy.

Donation After Circulatory Determination of Death Donor Characteristics and Lung Donor Utilization Within the United States

2015 ◽  
Vol 34 (4) ◽  
pp. S280-S281
Author(s):  
J.J. Mooney ◽  
H. Hedlin ◽  
P.K. Mohabir ◽  
R.V. Guillamet ◽  
R. Ha ◽  
...  
Keyword(s):  
United States ◽  
The United States ◽  
Determination Of Death ◽  
Donor Characteristics
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