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.

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.

Return of Spontaneous Respiration in an Infant Who Fulfilled Current Criteria to Determine Brain Death

PEDIATRICS ◽  
1995 ◽  
Vol 96 (3) ◽  
pp. 518-520
Author(s):  
Ken Okamoto ◽  
Tsuyoshi Sugimoto
Keyword(s):  
Young Children ◽  
Brain Death ◽  
American Academy ◽  
Task Force ◽  
Spontaneous Respiration ◽  
American Academy Of Pediatrics ◽  
New Guidelines ◽  
Current Guidelines ◽  
Child's Brain

It is generally assumed that the child's brain is more resistant to insults leading to death. Current guidelines for brain death, therefore, avoid application of these standards to young children.1 The determination of brain death in children, however, has become increasingly important, and different sets of new guidelines for children have been recently published.1-4 Especially, the recommendations of a special task force, consisting of representatives from neurologic organizations and the American Academy of Pediatrics, were published in five major journals.4 Those primary distinctions were three separate longer observation periods depending on the child's age and the necessity for two corroborating electroencephalograms (EEGs) or one EEG with a corroborating cerebral radionucleotide angiogram.

The Determination of Death under Polish Law in Comparative, Historical and Medical Perspective

2020 ◽  
pp. 1-20
Author(s):  
Leszek Bosek ◽  
Witold Borysiak
Keyword(s):  
Brain Death ◽  
Determination Of Death ◽  
Medical Background ◽  
Polish Law ◽  
The Brain ◽  
Irreversible Cessation ◽  
Medical Perspective

Abstract It has been recently adopted under Polish law that the determinant of death is both the brain death criterion, tantamount to the permanent and irreversible cessation of its function, and the equally valid circulatory criterion. This means that the determination of brain death is not indispensable to pronounce a person dead, because the irreversible cessation of circulation is sufficient in this respect. The purpose of this article is to present current developments in Polish law against the comparative, historical and medical background.

Death, Brain Death, and the Limits of Science: Why the Whole-Brain Concept of Death is a Flawed Public Policy

2010 ◽  
Vol 38 (3) ◽  
pp. 667-683 ◽  
Author(s):  
Mike Nair-Collins
Keyword(s):  
Public Policy ◽  
Brain Death ◽  
Brain Stem ◽  
Real World ◽  
Determination Of Death ◽  
Whole Brain ◽  
Legislative Changes ◽  
The Brain ◽  
Irreversible Cessation

The 1981 Uniform Determination of Death Act (UDDA) states:An individual that 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.The “whole-brain concept of death,” appealed to in the UDDA, has been roundly criticized for many years. However, despite a great deal of legitimate criticism in academic circles no real clinical or legislative changes have come about. At least one reason for this inertia is aptly stated by James Bernat, one of the principal and founding proponents of the brain death doctrine: “In the real world of public policy on biological issues, we must frequently make compromises or approximations to achieve acceptable practices and laws.” While acknowledging that the brain death doctrine is not flawless and that he and other proponents have been unable to address all valid criticisms, Bernat nonetheless maintains that the brain death doctrine is optimal public policy.

scholarly journals Pope John Paul II and the Neurological Standard for the Determination of Death: A Critical Analysis of his Address to the Transplantation Society

2017 ◽  
Vol 84 (2) ◽  
pp. 155-186 ◽  
Author(s):  
Doyen Nguyen
Keyword(s):  
Brain Death ◽  
Catholic Church ◽  
The Body ◽  
Human Organism ◽  
Determination Of Death ◽  
Pope John Paul Ii ◽  
John Paul Ii ◽  
The Brain ◽  
The Catholic Church

The introduction of the “brain death” criterion constitutes a significant paradigm shift in the determination of death. The perception of the public at large is that the Catholic Church has formally endorsed this neurological standard. However, a critical reading of the only magisterial document on this subject, Pope John Paul II's 2000 address, shows that the pope's acceptance of the neurological criterion is conditional in that it entails a twofold requirement. It requires that certain medical presuppositions of the neurological standard are fulfilled, and that its philosophical premise coheres with the Church's teaching on the body-soul union. This article demonstrates that the medical presuppositions are not fulfilled, and that the doctrine of the brain as the central somatic integrator of the body does not cohere either with the current holistic understanding of the human organism or with the Church's Thomistic doctrine of the soul as the form of the body. Summary The concept of “brain death” (the neurological basis for legally declaring a person dead) has caused much controversy since its inception. In this regard, it has been generally perceived that the Catholic Church has officially affirmed the “brain death” criterion. The address of Pope John Paul II in 2000 shows, however, that he only gave it a conditional acceptance, one which requires that several medical and philosophical presuppositions of the “brain death” standard be fulfilled. This article demonstrates, taking into consideration both the empirical evidence and the Church's Thomistic anthropology, that the presuppositions have not been fulfilled.

Guidelines for the Determination of Brain Death in Children

PEDIATRICS ◽  
1989 ◽  
Vol 83 (4) ◽  
pp. 629-629
Author(s):  
RICHARD M. NARKEWICZ
Keyword(s):  
Brain Death ◽  
American Academy ◽  
Task Force ◽  
American Academy Of Pediatrics ◽  
Sensitive Issue ◽  
Official Policy ◽  
Medical Disciplines ◽  
Consensus Report

In 1986, a task force was impaneled consisting of representatives from a number of legal and medical disciplines, including two representatives from the American Academy of Pediatrics, to examine the issue of brain death in children. This consortium developed a consensus report which was published in Pediatrics (1987;80:298-300). This report, however, does not represent Academy policy and should not be construed as such. This material has been referenced subsequently, most recently in the August (1988) issue of Pediatrics, with the inference that it represents the Academy's position. In summary, the guidelines issued by the Task Force have provided the medical and legal communities with useful information on a sensitive issue, but it should be reiterated that they do not represent an official policy of the American Academy of Pediatrics.

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