Brain death: what health professionals should know

Brain death is not a new phenomenon—it has been clearly established in clinical medicine and law for decades. Nonetheless, controversial cases involving brain death erupt into the news with distressing regularity. One recent example is the case of Jahi McMath, a California adolescent who met the criteria for brain death due to complications after a routine tonsillectomy. Jahi's family was devastated, understandably, but their desolation took the form of denying that their child was dead. The McMath family succeeded in having the body of their deceased daughter transferred to the morgue, and then to another facility, which allegedly will continue to maintain Jahi's organs as long as possible. In another recent and distressing case, Marlise Munoz, a young pregnant wife and mother in Texas suffered a massive blood clot to her lungs late one night. The patient—and her fetus of 14 weeks gestation—suffered a prolonged period without oxygen, resulting in loss of all brain function for the mother. The Texas hospital to which Munoz was admitted told her grieving husband that she met criteria for brain death, but refused to declare her dead, claiming instead that Texas law required them to maintain Munoz's organs in order to preserve the life of her fetus. This case is unusual in that it was the health care facility, not the family, who rejected the diagnosis of brain death. Munoz’s husband took the hospital to court, where a judge sensibly found that no Texas (or other) law can require that dead people receive medical care. The hospital was forced to declare Munoz dead and disconnect her from the ventilator. All parties agreed that the fetus was not and had never been viable. After 2 months of trauma, the Munoz family was able to mourn their loss. These 2 awful cases will fade from the news, as have other controversial brain-death cases before them. The trauma for the affected families will last far longer than the public’s memory. Sadly, other cases will likely take their place in the years to come, since brain death remains deeply confusing to the news media, to families, and even to some health professionals. However, there are steps that health professionals can take to help prevent others from enduring this type of trauma. First, it is important to review and clarify key concepts related to brain death. Inexplicably, many health professionals do not have a clear grasp of brain death’s definition and assessment. No group of health professionals is blameless; doctors, nurses, social workers, and others within the health professions make incorrect statements about brain death. And even among those who are well informed, poor use of language when communicating with families of brain dead patients is disturbingly common. To address these problems, we’ll begin with a brief review of brain death and some of the challenges related to it. Next, we'll think about better ways that health professionals can talk with families and colleagues about brain death. Finally, we examine ways to support best practices through policy and education, so that our communities are shielded from the trauma of these public controversies.