American Academy of Neurology Calls for Uniformity of Brain Death Determination

The  American Academy of Neurology is calling for uniform brain death laws, policies and practices in a new position statement published in the January 2, 2019, online issue of Neurology. The position statement is endorsed by the American Neurological Association and the Child Neurology Society. (HT: AAN press release)

Brain death is defined as the death of the individual due to irreversible loss of function of the entire brain. It is the equivalent of circulatory death, which is due to irreversible loss of function of the circulatory system, which includes the heart. 

The brain death standards for adults and children that are widely accepted by the medical profession are the following guidelines: the American Academy of Neurology’s 2010 Evidence-Based Guideline Update: Determining Brain Death in Adults; and the 2011 Guidelines for the Determination of Brain Death in Infants and Children, published by the Pediatric Section of the Society of Critical Care Medicine, the Sections of Neurology and Critical Care of the American Academy of Pediatrics and the Child Neurology Society. 

The AAN is not aware of any cases in which following these guidelines led to inaccurate determination of death with return of any brain function, including consciousness, brainstem reflexes or breathing. Yet only the state of Nevada has adopted legislation that requires using these widely accepted brain death guidelines as the medical standard, as authorized by the Uniform Determination of Death Act, for the determination of brain death.

“The AAN believes that a specific, uniform standard for the determination of brain death is critically important to provide the highest quality patient-centered neurologic and end-of-life care,” said position statement author James Russell, DO, MS, of Lahey Hospital and Medical Center in Burlington, Mass., and a Fellow of the American Academy of Neurology and chair of the Ethics, Law and Humanities Committee. “The AAN supports the development of legislation in every state modeled after the Nevada statute, which specifically defers to these current adult and pediatric brain death guidelines and any future updates.”

The AAN position statement also calls for uniform policies in medical facilities across the country that would ensure compliance to the brain death guidelines.

“The lack of specificity in most states’ laws, coupled with inconsistency among brain death protocols in medical facilities, has contributed to differing interpretations by the courts in a few high-profile cases,” said Russell. “The AAN wants the general public to know that when these guidelines are followed, the result is an accurate determination of brain death.”

The position statement also supports the development of programs that train and credential physicians that determine death by neurological criteria and that provide public and professional education regarding brain death and its determination.

Recognizing that each case is unique, the AAN position statement also provides guidance to medical professionals when a family may not accept a determination of death of their loved one due to religious, moral or cultural reasons, and requests continued life support. The position statement states that continuing to provide life support when a person is dead may deprive that person of dignity or provide false hope to the family.