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Commentary: False Positives in the Diagnosis of Brain Death

Published online by Cambridge University Press:  17 September 2019

MICHAEL NAIR-COLLINS  and
FRANKLIN G. MILLER
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Commentary
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Cambridge Quarterly of Healthcare Ethics , Volume 28 , Special Issue 4: Clinical Neuroethics , October 2019 , pp. 648 - 656
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Copyright © Cambridge University Press 2019 

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References

Notes

1. See President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Defining Death. Medical, Ethical, and Legal Issues in the Determination of Death. Washington, DC: US Government Printing Office; 1981, at 55–84.Google Scholar

2. Wijdicks, EF, Varelas, PN, Gronseth, GS, Greer, DM. 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.CrossRefGoogle ScholarPubMed Pediatric guidelines are detailed in Nakagawa, TA, Ashwal, S, Mathur, M, Mysore, M, Society of Critical Care Medicine, Section on Critical Care and Section on Neurology of American Academy of Pediatrics, Child Neurology Society. Guidelines for the determination of brain death in infants and children: An update of the 1987 Task Force Recommendations. Pediatrics 2011;128(3):e720–e740.Google Scholar

3. Halevy, A, Brody, B. Brain death: Reconciling definitions, criteria, and tests. Annals of Internal Medicine 1993;119(6):519–25.CrossRefGoogle ScholarPubMed For a recent review of hypothalamic function in patients diagnosed as brain dead, see Nair-Collins, M, Northrup, J, Olcese, J. Hypothalamic-pituitary function in brain death: A review. Journal of Intensive Care Medicine 2016;31(1):41–50.CrossRefGoogle ScholarPubMed

4. Dalle Ave, AL, Bernat, JL. Inconsistencies between the criterion and tests for brain death. Journal of Intensive Care Medicine 2018:1–9Google ScholarPubMed (epub before print.) PMID 29929410. See also Shewmon, DA. False positive diagnosis of brain death following the pediatric guidelines: Case report and discussion. Journal of Child Neurology 2017;32(14):1104–17.CrossRefGoogle ScholarPubMed

5. Bernat, JL. The whole-brain concept of death remains optimum public policy. Journal of Law, Medicine, and Ethics 2006:35–43.CrossRefGoogle ScholarPubMed

6. Wijdicks, EF. The case against confirmatory tests for determining brain death in adults. Neurology 2010;75(1):77–83.CrossRefGoogle ScholarPubMed See also note 5, Bernat 2006.

7. Shemie, SD, Hornby, L, Baker, A, Teitelbaum, J, Torrance, S, Young, K, et al. International guideline development for the determination of death. Intensive Care Medicine 2014;40(6):788–97.CrossRefGoogle ScholarPubMed

8. Russell, JA, Epstein, LG, Greer, DM, Kirschen, M, Rubin, MA, Lewis, A, et al. AAN position statement. Brain death, the determination of brain death, and member guidance for brain death accommodation requests. Neurology 2019;92:1–5.CrossRefGoogle Scholar In this “position statement” by the American Academy of Neurology (AAN), the authors write on page 3: “The AAN endorses the perspective of the UDDA that brain death has occurred when the irreversible loss of all functions of the entire brain including the brainstem has been determined. However, the AAN endorses the belief that preserved neuroendocrine function may be present … and is not inconsistent with the whole brain standard of death.” The assertion that some brain function may persist while remaining consistent with the whole brain standard that requires all brain function to cease is a logical contradiction and therefore is necessarily false.

9. Bernat, JL, Dalle Ave, AL. Aligning the criterion and tests for brain death. Cambridge Quarterly of Healthcare Ethics 2019;28(4):635–41.Google Scholar

10. See note 9, Bernat, Dalle Ave 2019, at 638.

11. See note 5, Bernat 2006.

12. See note 9, Bernat, Dalle Ave 2019, at 639.

13. Academy of Medical Royal Colleges. A Code of Practice for the Diagnosis and Confirmation of Death. 2008; available at http://www.aomrc.org.uk/reports-guidance/ukdec-reports-and-guidance/code-practice-diagnosis-confirmation-death/ (last accessed 27 Feb 2019).Google Scholar

14. See the articles listed in note 2.

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16. See note 9, Bernat, Dalle Ave 2019.

17. See note 9, Bernat, Dalle Ave 2019, at 636.

18. See note 3, Nair-Collins et al. 2016.

19. See the articles listed in note 2.

20. See note 9, Bernat, Dalle Ave 2019, at 639.

21. Note 9, Bernat, Dalle Ave 2019, at 638.

22. Coimbra, CG. Implications of ischemic penumbra for the diagnosis of brain death. Brazilian Journal of Medical and Biological Research 1999;32(12):1479–87.CrossRefGoogle Scholar

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24. Nygaard, CE, Townsend, RN, Diamond, DL. Organ donor management and organ outcome: A 6-year review from a Level I trauma center. Journal of Trauma 1990;30(6):728–32.CrossRefGoogle ScholarPubMed

25. Varelas, PN, Rehman, M, Abdelhak, T, Patel, A, Rai, V, Barber, A, et al. Single brain death examination is equivalent to dual brain death examinations. Neurocritical Care 2011;15(3):547–53.CrossRefGoogle ScholarPubMed

26. Note 13, Academy of Medical Royal Colleges 2008.

27. McGee, A, Gardiner, D. Differences in the definition of brain death and their legal impact on intensive care practice. Anaesthesia 2019:doi:10.1111/anae.14568.CrossRefGoogle ScholarPubMed

28. See the articles listed in note 4.

29. See note 23, Shewmon 2018.

30. Declaration of D. Alan Shewmon, M.D. in the case of Jahi McMath; available at http://www.thaddeuspope.com/images/Shewmon_Decl._12-2017.pdf (last accessed 2 Mar 2019).

31. We respect the family’s right to control dissemination of their private videos and do not suggest that they have any obligation to release them further. Additionally, several videos are available in the public domain already.

32. See note 23, Shewmon 2018, at 169.

33. Note 23, Shewmon 2018, at 167.

34. For example, see McMahan, J. The Ethics of Killing: Problems at the Margins of Life . New York, NY: Oxford University Press; 2002.CrossRefGoogle Scholar

35. President’s Council on Bioethics. Controversies in the Determination of Death: A White paper by the President’s Council on Bioethics . Washington, DC; 2008.Google Scholar

36. See note 7, Shemie et al. 2014.

37. Giacino, JT, Fins, JJ, Laureys, S, Schif, ND. Disorders of consciousness after acquired brain injury: The state of the science. Nature Reviews Neurology 2014;10(2):99–114.CrossRefGoogle ScholarPubMed

38. Miller, FG, Truog, RD. Death, Dying, and Organ Transplantation. Reconstructing Medical Ethics at the End of Life . New York, NY: Oxford University Press; 2012.Google Scholar Nair-Collins, M. Can the brain-dead be harmed or wronged? On the moral status of brain death and its implications for organ procurement. Kennedy Institute of Ethics Journal 2017;27(4):525–59.CrossRefGoogle ScholarPubMed

39. But see Du Toit, J, Miller, FG. The ethics of continued life-sustaining treatment for those diagnosed as brain-dead. Bioethics 2016;30:151–8,CrossRefGoogle ScholarPubMed and note 38, Nair-Collins 2017.