Fwd: AAN Calls for Uniform Definition of Brain Death

David Katz d.katz at MAIL.UTORONTO.CA
Fri Jan 4 02:33:30 UTC 2019


Brain death is NOT the ultimate diagnostic issue.
Brain death is extremely well defined and there are many algorithmic and easy to follow approaches to applying this definition.
Stories about people who 'woke up' do not challenge the diagnosis but the approach that was taken to get to this diagnosis. If the other disease states I encountered in the ICU had the same diagnostic rigour to their definition as brain death does, then my rate of diagnostic error would be greatly reduced. Stories of diagnostic uncertainty when it comes to brain death are almost universally sensationalized because of the nature of the topic.
From the article that you referenced;
a) "But at the same time there is no way of knowing how many people recover from brain death because they are usually quickly removed from life support or become organ donors.”
- This is not true, there is good data from the MIddle East, Israel, New York and New Jersey. All jurisdictions that allow religious objection to the application of brain death.
b) "Subsequently, two neurologists stated that McMath was not brain dead based on their interpretation of an EEG, an MRI, and an MRA done a year later and observation of video clips from 2014 to 2016 that appeared to show McMath following commands and communicating with finger movements.”
- In most jurisdictions EEG, MRI and videos are not the correct tests to use in the determination of brain death so certainly should not be used to challenge the diagnosis. The only test that is useful here is MRA and even that is only supposed to be used when a clinical exam cannot be completed.
Amongst the medical community there is very little debate as to the definition of brain death. There are some regional differences in the approach taken to reaching the diagnosis. The debate happens outside of medicine where differing societal views debate whether brain death equals circulatory death. See recent case (McKitty v. Hayani) in Ontario.

David Katz MD FRCPC MSc
Adult Critical Care Medicine
Internal Medicine
On Jan 3, 2019, 8:49 PM -0500, HM Epstein <hmepstein at GMAIL.COM>, wrote:
The AAN is looking to harden a federal definition of brain death, the ultimate diagnostic issue. But it was just a few month ago I shared an article<https://www.medscape.com/viewarticle/902143?> that discussed how difficult it was to do that because of the number of "dead" patients who "woke" or moved in ways that indicated the assessment was premature.  A pull-out from the attached article available free for all to read:


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.

Does SIDM have a point-of-view on this? Should we? And my fear is that bureaucracy is incredibly slow moving. If this definition is accepted, how hard will it be to update?

Best,
Helene
[https://drive.google.com/uc?id=0BzqkjTYl6PKwNUhEU2NyZ2RsNW8&export=download]

Website<http://hmepstein.com/> Twitter<https://twitter.com/hmepstein>
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---------- Forwarded message ---------
From: Medscape News Alert <Medscape_News_Alert at mail.medscape.com<mailto:Medscape_News_Alert at mail.medscape.com>>
Date: Thu, Jan 3, 2019 at 5:32 PM
Subject: AAN Calls for Uniform Definition of Brain Death
To: <HMEPSTEIN at gmail.com<mailto:HMEPSTEIN at gmail.com>>


Breaking medical news alert for January 3, 2019.
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