American Academy of Neurology Call for Uniformity in Brain Death Standards

Thursday, January 03, 2019


Noting that only 1 state, Nevada, has adopted legislation requiring use of medically accepted guidelines for determining brain death, the American Academy of Neurology (AAN) is calling for action on this important issue. In a position paper published in the AAN journal Neurology, the AAN advocates that all states adopt legislation specifying that medical determination of brain death be made in accordance with evidence-based guidelines for adults published by the AAN and for children copublished by the Society of Critical Care Medicine (SCCM), Child Neurology Society (CNS), and American Academy of Pediatrics (AAP). The position paper is endorsed by the American Neurologic Association (ANA) and the CNS.

Published guidelines define brain death as death of the individual due to irreversible loss of entire brain function and provide standardized, evidence-based methods to test for loss of entire brain function. The AAN notes that they are not aware of any use of these guidelines that has ever led to inaccurate determination of brain death followed by any return of any brain function in an individual. 

The position paper notes that every individual situation is unique and provides guidance to medical professionals in situations when a family may not accept the determination of brain death, noting that continuing to provide life support when a person is dead may deprive that person of dignity or provide false hope to the family.

In addition to calling upon legislatures to adopt uniform legal standards, the AAN calls upon medical facilities and health care systems to adopt uniform policies to ensure compliance with the brain death guidelines. The position statement also supports the development of training and credentialing programs to train physicians in determining brain death and educate the public about brain death.

Position statement author James Russell, DO, MS, FAAN of Lahey Hospital and Medical Center in Burlington, MA who is Chair of the AAN Ethics, Law, and Humanities Committee said, “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 and 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 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,” continued Russell. “The AAN wants the general public to know that when these guidelines are followed, the result is an accurate determination of brain death.”

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