AAN Calls for Uniform Definition of Brain Death

Megan Brooks

January 03, 2019

The American Academy of Neurology (AAN) has issued a position statement calling on US lawmakers to require a uniform definition 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," James Russell, DO, first author of the statement and chair of the AAN's Ethics, Law, and Humanities Committee, said in a news release.

The position statement was published online January 2 in Neurology. It has been endorsed by the American Neurological Association and the Child Neurology Society.

Following Nevada's Lead

According to the AAN, brain death is defined as death due to irreversible loss of function of the entire brain — comparable to circulatory death, which is defined as irreversible loss of function of the circulatory system. Such a state, as determined by one or more medical professionals through application of accepted medical standards, is accepted as legal death in all US jurisdictions.

The brain death standards for adults and children that are now widely accepted and used are the AANs 2010 Evidence-Based Guideline Update: Determining Brain Death in Adults and the 2011 Guidelines for the Determination of Brain Death in Infants and Children, issued by the Pediatric Section of the Society of Critical Care Medicine, the Sections of Neurology and Critical Care, the American Academy of Pediatrics and the Child Neurology Society.

The AAN says it is not aware of any cases in which use of these guidelines led to inaccurate determination of death with return of any brain function. Yet only the state of Nevada has adopted legislation that requires use of these brain death guidelines as the medical standard.

"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," said Russell, of Lahey Hospital and Medical Center in Burlington, Massachusetts.

The AAN also calls for uniform policies across US medical centers 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."

In addition, the AAN encourages the development of programs that train and credential physicians who determine brain death and that public and professional education be provided regarding brain death and its determination.

The AAN position statement also provides guidance to medical professionals regarding circumstances in which a family may not accept a determination of death of a loved one for religious, moral, or cultural reasons and requests continued life support.

"This guidance is provided in response to an AAN-sponsored survey of its members, in which respondents requested that clear, simple, and universal guidelines be provided on how to respond to objections to determination of death by neurologic criteria and requests for temporary or indefinite accommodation," the AAN explains.

Although the AAN is "respectful of and sympathetic toward requests for limited accommodation based on reasonable and sincere social, moral, cultural, and religious considerations," it acknowledges that there is "no ethical obligation to provide medical treatment to a deceased person. The AAN recognizes the potential for harm to the patient, the family, or other patients and the health care team from indefinite accommodation," the guideline states.

It further states that a neurologist who is opposed to indefinite accommodation on the basis of religious or moral conscience should be allowed to transfer the care of a deceased person to another individual if possible, "without reprisal, if continued care is mandated by law or institutional policy."

The AAN also states that if, on the basis of religious or moral conscience, a neurologist is opposed to determining brain death, he or she should seek to transfer this responsibility to another qualified physician.

Development of the position statement was funded by the AAN. The authors have disclsoed no relevant financial relationships.

Neurology. Published online January 2, 2019. Abstract

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