New Brain Death Criteria: Reaching Consensus
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Published 2024-07-23
www.medscape.com/viewarticle/999866?src=soc_yt
-- TRANSCRIPT --
Andrew N. Wilner, MD: Welcome to Medscape. I'm Dr Andrew Wilner. Today, I have the pleasure of speaking with Dr Lucas Elijovich. Lucas is a colleague of mine, and he's also a specialist in critical care and director of neurocritical care at University of Tennessee Health Science Center (UTHSC), where we both work. Welcome, Lucas.
Lucas Elijovich, MD: Thanks, Andrew. It's a pleasure to be with you. I appreciate Medscape's invitation to talk about the update on the brain death criteria and guidelines.
Defining Death and Saving Lives
Wilner: As a neurocritical care physician, I thought that the updated version of the brain death guidelines is very pertinent for you and your colleagues. I thought it's worth a discussion. I remember the last update was in 2010, where they decided that the previous update was acceptable.
I wanted to talk about this latest 2023 update of the brain death guidelines. I know you've had a chance to look at it. How are you going to use it in your daily work?
Elijovich: First, it's part of the everyday work of a neurointensivist. I think all neurointensivists, and really all critical care physicians, need to review it. It hasn't changed tremendously since the last version, but there are some aspects that we'll talk about today.
The other thing I would say is that it's a very rigorous look at these guidelines, and a reevaluation of them. There's a consensus of specialists, ranging from neurosurgeons, neurologists, and medical critical care doctors to radiologists and pediatricians.
One of the primary goals of this new guideline was to merge the pediatric and adult guidelines together, which I think makes sense so you don't have to go looking in multiple places. When you're dealing with teenagers, who may bridge some of these clinical situations, it's good to have all the information in one place. I was pleased to see that.
The methodology was a modified Delphi consensus to come up with the recommendations and revisions. We're not going to go into that methodology, but you can look it up. I think it is very rigorous, and it's clearly multidisciplinary. I think it's very well done.
Wilner: To put these guidelines in perspective, as a neurocritical care physician, how often in a week would you need to apply these brain death guidelines? How often in a month? How necessary are they?
Elijovich: They're vital to what we do, especially. They're not just vital to the individual patient; they're vital to the community. One of the things that happens when patients die — and happens to all of us — is that some of us are organ donors, and some of us don't know that we want to be organ donors, but our families want us to be. Determining brain death is very important in that process. It's vital to that process.
To your first question, this happens every day in the neurocritical care unit. I was on service 2 weeks ago, and we did this almost every day, unfortunately. Sometimes, that results in a gain of multiple people's lives and saving people's lives. As a fellow, one of the most transformative things that happened to me when I was at UCSF was that the organ donor network in California would send us letters if we were involved in the care of someone who donated and tell us that we saved lives. These criteria don't just help us define death, but they help us save lives.
Wilner: It's a formal way that everyone agrees upon to say that this patient is clinically dead, is not going to wake up, and that it's acceptable to proceed with organ procurement?
Elijovich: It's not always about organ procurement. Sometimes, it's just about being able to give a real prognosis and let families begin the grieving process and know what really happened. That's equally, if not more, important.
That's our first duty, and one of the things that this guideline talks about is that it's a duty of a critical care physician or neurocritical care physician to determine the extent of injury and when brain death — or death by neurologic criteria, as it's discussed in this document — is suspected to define that and that you don't need consent. It's part of normal medical care to identify death by neurologic criteria or brain death.
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www.medscape.com/viewarticle/999866?src=soc_yt