Editors' note: An interdisciplinary response to contemporary concerns about brain death determination

Abstract

“An interdisciplinary response to contemporary concerns about brain death determination” generated several readers' responses. Commenting on the paper, Verheijde et al. argue that cardiopulmonary death is not the equivalent to brain death and add that public trust in brain death requires that there be zero false-positive determinations of death. Dr. Sethi suggests that lawsuits related to brain death may be linked more to breakdowns in communication between the medical teams and patient families rather than validity of determination of death by neurologic criteria. Machado et al. suggest that ancillary tests should have a decisive role in helping to delineate the brain death concept since clinical evaluation might have pitfalls. Finally, Dr. Shabtai feels that it is an error to frame the debate as one of religious or moral beliefs vs science, and suggests continued discussion, including broad public debate. Authors Lewis et al. defend their article citing several prominent American medical societies who support that brain death is equivalent to cardiopulmonary death. They add that when the American Academy of Neurology guidelines are appropriately applied, there are zero false-positive determinations of death. They suggest including a social worker, psychologist, palliative care specialist, chaplain, and religious figure in conversations about brain death. They explain that ancillary testing is recommended to assess for lack of intracranial blood flow or cerebral activity if a clinical evaluation cannot be completed, but the gold standard for determination of brain death is a full clinical evaluation. Further, they add that ancillary testing is imperfect and there are risks when performing testing and interpreting the results. Finally, they remind the reader that the 1981 President's Commission determined that death should be defined based on complete loss of function of the brain or the heart and lungs, but deferred to the medical community to establish the specific criteria for determination of death. They stress that it is the medical community's responsibility to ensure that it is clear what constitutes “accepted medical standards” for determination of death and that these criteria are adhered to consistently and accurately. “An interdisciplinary response to contemporary concerns about brain death determination” generated several readers' responses. Commenting on the paper, Verheijde et al. argue that cardiopulmonary death is not the equivalent to brain death and add that public trust in brain death requires that there be zero false-positive determinations of death.