Brain death, the determination of brain death, and member guidance for brain death accommodation requests

The American Academy of Neurology holds the following positions regarding brain death and its determination, and provides the following guidance to its members who encounter resistance to brain death, its determination, or requests for accommodation including continued use of organ support technology despite neurologic determination of death. The medical professions ability to determine death accurately, whether caused by irreversible brain or circulatory failure, is integral to the maintenance of the public trust in the professions fulfillment of its fiduciary responsibility to its patients. In 1981, the Uniform Determination of Death Act (UDDA) was published, a statute proposed by the American Bar Association, the American Medical Association, the National Conference of Commissioners on Uniform State Laws, and the Presidents Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research.1-4 The UDDAs position served to address a societal problem created in the mid-20th century as a consequence of the development of mechanical ventilation and other organ-sustaining technologies. As a result, irreversibly brain-injured individuals could have their physiologic existence sustained for variable periods of time. The purpose of the UDDA was to establish a uniform definition of death, determined by acceptable medical standards, that was clear and socially accepted, with the intention of being adopted in every US jurisdiction. The Presidents Commission and the UDDA considered death to be a unitary phenomenon regardless of causation, resulting from either irreversible failure of brain or circulatory function. It recognized the biological facts of universal applicability, while seeking to protect patients against ill-advised idiosyncratic pronouncements of death. The UDDA perspectives are supported by a preponderance of medical and legal authorities, the original UDDA wording having been supported by the American Academy of Neurology (AAN).1,5 Brain death is death of the individual due to irreversible loss of function to the entire brain. Otherwise known as death by neurologic criteria, it is accepted as legal death in all US jurisdictions, as determined by one or more medical professionals through application of accepted medical standards.5-11 The standards for adult and pediatric patients that are currently widely accepted by the medical profession are the 2010 Evidence-Based Guideline Update: Determining Brain Death in Adults (endorsed by the Neurocritical Care Society, the Child Neurology Society, the Radiologic Society of North America, and the American College of Radiology) and the 2011 Guidelines for the Determination of AAN = American Academy of Neurology; AAP = American Academy of Pediatrics; CNS = Child Neurology Society; SCCM=Society of Critical Care Medicine; UDDA = Uniform Determination of Death Act.