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Clinical and Bioethical Perspective on Brain Death, Organ Donation, and Family Communication

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Traumatic Brain Injury

Part of the book series: Hot Topics in Acute Care Surgery and Trauma ((HTACST))

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Abstract

The concept of brain death emerged about 60 years ago, when the development of ventilators and other intensive care unit technologies allowed patients with devastating neurological injury to be kept alive for prolonged periods. Although it has been accepted as a legal criterion for determining death for over 50 years, death by neurological criteria remains controversial in the USA. Significant variability still exists in clinical practice and legal application. In this chapter, the essential clinical and ethical elements of brain death are discussed.

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References

  1. Truog RD, Berlinger N, Zacharias RL, Solomon MZ. Brain death at fifty: exploring consensus, controversy, and contexts. Hast Cent Rep. 2018;48(Suppl 4):S2–5.

    Google Scholar 

  2. Capron AM. Beecher Dépassé: fifty years of determining death, legally. Hastings Cent Rep. 2018;48(Suppl 4):S14–S8.

    PubMed  Google Scholar 

  3. De Georgia MA. History of brain death as death: 1968 to the present. J Crit Care. 2014;29(4):673–8.

    Article  PubMed  Google Scholar 

  4. A definition of irreversible coma. Report of the Ad Hoc Committee of the Harvard Medical School to examine the definition of brain death. JAMA. 1968;205(6):337–40.

    Google Scholar 

  5. https://www.uniformlaws.org/committees/community-home/librarydocuments?communitykey=155faf5d-03c2-4027-99ba-ee4c99019d6c&tab=librarydocuments&LibraryFolderKey=&DefaultView=. Accessed 21 Jun 2020.

  6. Nikas NT, Bordlee DC, Moreira M. Determination of death and the dead donor rule: a survey of the current law on brain death. J Med Philos. 2016;41(3):237–56.

    Article  PubMed  PubMed Central  Google Scholar 

  7. https://www.aan.com/Guidelines/home/GuidelineDetail/431.

  8. Greer DM, Kirschen MP, Lewis A, Gronseth GS, Rae-Grant A, Ashwal S, et al. Pediatric and adult brain death/death by neurologic criteria consensus guideline: report of the AAN guidelines subcommittee, AAP, CNS, and SCCM. Neurology. 2023;1:1. https://doi.org/10.1212/WNL.0000000000207740.

    Article  Google Scholar 

  9. Wijdicks EF. The case against confirmatory tests for determining brain death in adults. Neurology. 2010;75(1):77–83.

    Article  PubMed  Google Scholar 

  10. Robbins NM, Bernat JL. Practice current: when do you order ancillary tests to determine brain death? Neurol Clin Pract. 2018;8(3):266–74.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Bradac GB, Simon RS. Angiography in brain death. Neuroradiology. 1974;7(1):25–8.

    Article  CAS  PubMed  Google Scholar 

  12. Braum M, Ducrocq X, Huot JC, Audibert G, Anxionnat R, Picard L. Intravenous angiography in brain death: report of 140 patients. Neuroradiology. 1997;39(6):400–5.

    Article  CAS  PubMed  Google Scholar 

  13. Savard M, Turgeon AF, Gariépy JL, Trottier F, Langevin S. Selective 4 vessels angiography in brain death: a retrospective study. Can J Neurol Sci. 2010;37(4):492–7.

    Article  PubMed  Google Scholar 

  14. Sinha P, Conrad GR. Scintigraphic confirmation of brain death. Semin Nucl Med. 2012;42(1):27–32.

    Article  PubMed  Google Scholar 

  15. Chang JJ, Tsivgoulis G, Katsanos AH, Malkoff MD, Alexandrov AV. Diagnostic accuracy of transcranial Doppler for brain death confirmation: systematic review and meta-analysis. AJNR Am J Neuroradiol. 2016;37(3):408–14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Szurhaj W, Lamblin MD, Kaminska A, Sediri H, Société de Neurophysiologie Clinique de Langue Française. EEG guidelines in the diagnosis of brain death. Neurophysiol Clin. 2015;45(1):97–104.

    Article  CAS  PubMed  Google Scholar 

  17. Wijdicks EF, Varelas PN, Gronseth GS, Greer DM, American Academy of Neurology. Evidence-based guideline update: determining brain death in adults: report of the quality standards subcommittee of the American Academy of Neurology. Neurology. 2010;74(23):1911–8.

    Article  PubMed  Google Scholar 

  18. Greer DM, Wang HH, Robinson JD, Varelas PN, Henderson GV, Wijdicks EF. Variability of brain death policies in the United States. JAMA Neurol. 2016;73(2):213–8.

    Article  PubMed  Google Scholar 

  19. Russell JA, Epstein LG, Greer DM, Kirschen M, Rubin MA, Lewis A, et al. Brain death, the determination of brain death, and member guidance for brain death accommodation requests: AAN position statement. Neurology. 2019;92:228.

    Article  PubMed  Google Scholar 

  20. https://www.leg.state.nv.us/Session/79th2017/Bills/AB/AB424_R1.pdf.

  21. Shappell CN, Frank JI, Husari K, Sanchez M, Goldenberg F, Ardelt A. Practice variability in brain death determination: a call to action. Neurology. 2013;81(23):2009–14.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Braksick SA, Robinson CP, Gronseth GS, Hocker S, Wijdicks EFM, Rabinstein AA. Variability in reported physician practices for brain death determination. Neurology. 2019;92(9):e888–e94.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Chen PM, Trando A, LaBuzetta JN. Simulation-based training improves fellows’ competence in brain death discussion and declaration. Neurologist. 2021;27(1):6–10.

    Article  PubMed  Google Scholar 

  24. Busl KM, Lewis A, Varelas PN. Apnea testing for the determination of brain death: a systematic scoping review. Neurocrit Care. 2020;34:608.

    Article  PubMed Central  Google Scholar 

  25. Migdady I, Stephens RS, Price C, Geocadin RG, Whitman G, Cho SM. The use of apnea test and brain death determination in patients on extracorporeal membrane oxygenation: a systematic review. J Thorac Cardiovasc Surg. 2020;48:364.

    Google Scholar 

  26. Shah SK, Kasper K, Miller FG. A narrative review of the empirical evidence on public attitudes on brain death and vital organ transplantation: the need for better data to inform policy. J Med Ethics. 2015;41(4):291–6.

    Article  PubMed  Google Scholar 

  27. Siminoff LA, Mercer MB, Arnold R. Families’ understanding of brain death. Prog Transplant. 2003;13(3):218–24.

    Article  PubMed  Google Scholar 

  28. Siminoff LA, Burant C, Youngner SJ. Death and organ procurement: public beliefs and attitudes. Kennedy Inst Ethics J. 2004;14(3):217–34.

    Article  PubMed  Google Scholar 

  29. Seifi A, Lacci JV, Godoy DA. Incidence of brain death in the United States. Clin Neurol Neurosurg. 2020;195:105885.

    Article  PubMed  Google Scholar 

  30. Jones AH, Dizon ZB, October TW. Investigation of public perception of brain death using the internet. Chest. 2018;154(2):286–92.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Lewis A, Lord AS, Czeisler BM, Caplan A. Public education and misinformation on brain death in mainstream media. Clin Transpl. 2016;30(9):1082–9.

    Article  Google Scholar 

  32. Lewis A, Weaver J, Caplan A. Portrayal of brain death in film and television. Am J Transplant. 2017;17(3):761–9.

    Article  CAS  PubMed  Google Scholar 

  33. Yang Q, Miller G. East-west differences in perception of brain death. Review of history, current understandings, and directions for future research. J Bioeth Inq. 2015;12(2):211–25.

    Article  PubMed  Google Scholar 

  34. Terunuma Y, Mathis BJ. Cultural sensitivity in brain death determination: a necessity in end-of-life decisions in Japan. BMC Med Ethics. 2021;22(1):58.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Miller AC, Ziad-Miller A, Elamin EM. Brain death and Islam: the interface of religion, culture, history, law, and modern medicine. Chest. 2014;146(4):1092–101.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Yanke G, Rady MY, Verheijde JL. When brain death belies belief. J Relig Health. 2016;55(6):2199–213.

    Article  PubMed  Google Scholar 

  37. Gabbay E, Fins JJ. Go in peace: brain death, reasonable accommodation and Jewish mourning rituals. J Relig Health. 2019;58(5):1672–86.

    Article  PubMed  Google Scholar 

  38. Morrison WE, Kirschen MP. A taxonomy of objections to brain death determination. Neurocrit Care. 2022;37(2):369–71.

    Article  PubMed  Google Scholar 

  39. https://law.justia.com/cases/arizona/supreme-court/1979/4271-2.html.

  40. https://law.justia.com/codes/arizona/2015/title-14/section-14-1107/.

  41. https://www.ncleg.gov/EnactedLegislation/Statutes/HTML/BySection/Chapter_90/GS_90-323.html#:~:text=%C2%A7%2090%2D323accepted%20standards%20of%20medical%20practice.

  42. https://law.justia.com/codes/georgia/2010/title-31/chapter-10/31-10-16/.

  43. Lewis A, Greer D. Current controversies in brain death determination. Nat Rev Neurol. 2017;13(8):505–9.

    Article  PubMed  Google Scholar 

  44. https://codes.findlaw.com/ca/health-and-safety-code/hsc-sect-1254-4.html.

  45. Pope T. Brain death and the law: hard cases and legal challenges. Hast Cent Rep. 2018;48(Suppl 4):S46–S8.

    Google Scholar 

  46. Lewis A, Scheyer O. Legal objections to use of neurologic criteria to declare death in the United States: 1968 to 2017. Chest. 2019;155(6):1234–45.

    Article  PubMed  Google Scholar 

  47. https://law.justia.com/cases/nevada/supreme-court/2015/68531.html.

  48. Bjelland S, Jones K. A systematic review on improving the family experience after consent for deceased organ donation. Prog Transplant. 2022;32(2):152–66.

    Article  PubMed  Google Scholar 

  49. Ma J, Zeng L, Li T, Tian X, Wang L. Experiences of families following organ donation consent: a qualitative systematic review. Transplant Proc. 2021;53(2):501–12.

    Article  PubMed  Google Scholar 

  50. Knihs NDS, Schuantes-Paim SM, Bellaguarda MLDR, Treviso P, Pessoa JLE, Magalhães ALP, et al. Family interview evaluation for organ donation: communication of death and information about organ donation. Transplant Proc. 2022;54(5):1202–7.

    Article  PubMed  Google Scholar 

  51. Meyfroidt G, Gunst J, Martin-Loeches I, Smith M, Robba C, Taccone FS, et al. Management of the brain-dead donor in the ICU: general and specific therapy to improve transplantable organ quality. Intensive Care Med. 2019;45(3):343–53.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Martin-Loeches I, Sandiumenge A, Charpentier J, Kellum JA, Gaffney AM, Procaccio F, et al. Management of donation after brain death (DBD) in the ICU: the potential donor is identified, what’s next? Intensive Care Med. 2019;45(3):322–30.

    Article  PubMed  Google Scholar 

  53. Robinson K. New drafting and study committees to be appointed. 2020; https://www.uniformlaws.org/committees/community-home/digestviewer/viewthread?MessageKey=a71e3d9d-4cf9-4529-9169-a08acf5edde6&CommunityKey=d4b8f588-4c2f-4db1-90e9-48b1184ca39a&tab=digestviewer.

    Google Scholar 

  54. Omelianchuk A, Bernat J, Caplan A, Greer D, Lazaridis C, Lewis A, et al. Revise the uniform determination of death act to align the law with practice through neurorespiratory criteria. Neurology. 2022;98(13):532–6.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Bioethics BotPCfC. Proposal for revising the uniform determination of death act. 2022; https://www.thehastingscenter.org/defining-brain-death/.

    Google Scholar 

  56. Manara AR. All human death is brain death: the legacy of the harvard criteria. Resuscitation. 2019;138:210–2.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Ascension Medical Group Seton Neurosurgery, Austin, TX, USA

    Vincent Y. Wang

  2. Department of Neurosurgery, Dell Medical School, University of Texas Austin, Austin, TX, USA

    Vincent Y. Wang

Authors
  1. Vincent Y. Wang
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Editor information

Editors and Affiliations

  1. Dept. Anesthesia & Intensive Care, Pisa University Hospital, Pisa, Italy

    Etrusca Brogi

  2. General, Emergency and Trauma Surgery Deptartment, Pisa University Hospital, PISA, Pisa, Italy

    Federico Coccolini

  3. Surgical Intensive Care Unit, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Eric J. Ley

  4. Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Alex Valadka

Brain Death/Death by Neurologic Criteria Checklist

Brain Death/Death by Neurologic Criteria Checklist

A chart represents the brain death slash death by neurologic criteria checklist. It includes prerequisites for clinical examination, prerequisite summary, clinical exam, and clinical examination results.
A continued chart represents the brain death slash death by neurologic criteria checklist. It includes A P N E A test, A P N E A testing prerequisites, A P N E A testing performed, and final apnea testing results.
A continued chart indicates the brain death slash death by neurologic criteria checklist. It includes ancillary testing, final ancillary testing results, and a summary of the findings.

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© 2024 The Author(s), under exclusive license to Springer Nature Switzerland AG

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Wang, V.Y. (2024). Clinical and Bioethical Perspective on Brain Death, Organ Donation, and Family Communication. In: Brogi, E., Coccolini, F., Ley, E.J., Valadka, A. (eds) Traumatic Brain Injury. Hot Topics in Acute Care Surgery and Trauma. Springer, Cham. https://doi.org/10.1007/978-3-031-50117-3_31

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  • DOI: https://doi.org/10.1007/978-3-031-50117-3_31

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-50116-6

  • Online ISBN: 978-3-031-50117-3

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