Perspectives of Medical Organizations, Organ Procurement Organizations, and Advocacy Organizations About Revising the Uniform Determination of Death Act (UDDA).
Brain death
Ethics
Medicolegal
UDDA
Uniform Law Commission
Journal
Neurocritical care
ISSN: 1556-0961
Titre abrégé: Neurocrit Care
Pays: United States
ID NLM: 101156086
Informations de publication
Date de publication:
26 Oct 2023
26 Oct 2023
Historique:
received:
19
08
2023
accepted:
29
09
2023
medline:
26
10
2023
pubmed:
26
10
2023
entrez:
25
10
2023
Statut:
aheadofprint
Résumé
The Uniform Law Commission paused work of the Drafting Committee to Revise the Uniform Determination of Death Act (UDDA) in September 2023. Thematic review was performed of comments submitted to the Uniform Law Commission by medical organizations (MO), organ procurement organizations (OPO), and advocacy organizations (AO) from 1/1/2023 to 7/31/2023. Of comments from 41 organizations (22 AO, 15 MO, 4 OPO), 34 (83%) supported UDDA revision (50% OPO, 33% MO recommended against revision). The most comments addressed modifications to "all functions of the entire brain, including the brainstem" (31; 95% AO, 75% OPO, 47% MO), followed by irreversible versus permanent (25; 77% AO, 50% OPO, 40% MO), accommodation of brain death/death by neurologic criteria (BD/DNC) objections (23; 100% OPO, 80% MO, 32% AO), consent for BD/DNC evaluation (18; 75% OPO, 47% MO, 36% AO), "accepted medical standards" (13; 36% AO, 33% MO, 0% OPO), notification before BD/DNC evaluation (14; 100% OPO, 53% MO, 9% AO), time to gather before discontinuation of organ support after BD/DNC determination (12; 60% MO, 25% OPO, 9% AO), and BD/DNC examiner credential requirements (2; 13% MO, 0% AO, 0% OPO). The predominant themes were that the revised UDDA should include the term "irreversible" and shouldn't (1) stipulate specific medical guidelines, (2) require notification before BD/DNC evaluation, or (3) require time to gather before discontinuation of organ support after BD/DNC determination. Views on other topics were mixed, but MO and OPO generally advocated for the revised UDDA to take a functional approach to BD/DNC, not require consent for BD/DNC evaluation, and not require opt-out accommodation of BD/DNC objections. Contrastingly, many AO and some MO with religious affiliations or a focus on advocacy favored the revised UDDA take an anatomic approach to BD/DNC or eliminate BD/DNC altogether, require consent for BD/DNC evaluation, and require opt-out accommodation of BD/DNC objections. Most commenting organizations support UDDA revision, but perspectives on the approach vary, so the Drafting Committee could not formulate revisions that would be agreeable to all stakeholders.
Sections du résumé
BACKGROUND
BACKGROUND
The Uniform Law Commission paused work of the Drafting Committee to Revise the Uniform Determination of Death Act (UDDA) in September 2023.
METHODS
METHODS
Thematic review was performed of comments submitted to the Uniform Law Commission by medical organizations (MO), organ procurement organizations (OPO), and advocacy organizations (AO) from 1/1/2023 to 7/31/2023.
RESULTS
RESULTS
Of comments from 41 organizations (22 AO, 15 MO, 4 OPO), 34 (83%) supported UDDA revision (50% OPO, 33% MO recommended against revision). The most comments addressed modifications to "all functions of the entire brain, including the brainstem" (31; 95% AO, 75% OPO, 47% MO), followed by irreversible versus permanent (25; 77% AO, 50% OPO, 40% MO), accommodation of brain death/death by neurologic criteria (BD/DNC) objections (23; 100% OPO, 80% MO, 32% AO), consent for BD/DNC evaluation (18; 75% OPO, 47% MO, 36% AO), "accepted medical standards" (13; 36% AO, 33% MO, 0% OPO), notification before BD/DNC evaluation (14; 100% OPO, 53% MO, 9% AO), time to gather before discontinuation of organ support after BD/DNC determination (12; 60% MO, 25% OPO, 9% AO), and BD/DNC examiner credential requirements (2; 13% MO, 0% AO, 0% OPO). The predominant themes were that the revised UDDA should include the term "irreversible" and shouldn't (1) stipulate specific medical guidelines, (2) require notification before BD/DNC evaluation, or (3) require time to gather before discontinuation of organ support after BD/DNC determination. Views on other topics were mixed, but MO and OPO generally advocated for the revised UDDA to take a functional approach to BD/DNC, not require consent for BD/DNC evaluation, and not require opt-out accommodation of BD/DNC objections. Contrastingly, many AO and some MO with religious affiliations or a focus on advocacy favored the revised UDDA take an anatomic approach to BD/DNC or eliminate BD/DNC altogether, require consent for BD/DNC evaluation, and require opt-out accommodation of BD/DNC objections.
CONCLUSIONS
CONCLUSIONS
Most commenting organizations support UDDA revision, but perspectives on the approach vary, so the Drafting Committee could not formulate revisions that would be agreeable to all stakeholders.
Identifiants
pubmed: 37880474
doi: 10.1007/s12028-023-01872-5
pii: 10.1007/s12028-023-01872-5
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.
Références
President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Defining death: medical, legal and ethical issues in the determination of death. Washington D.C.; 1981.
Lewis A, Cahn-Fuller K, Caplan A. Shouldn’t dead be dead?: the search for a uniform definition of death. J Law Med Ethics. 2017;45:112–28.
doi: 10.1177/1073110517703105
pubmed: 28661278
Lewis A, Bonnie RJ, Pope T. It’s time to revise the uniform determination of death act. Ann Intern Med. 2020;172:143–4.
doi: 10.7326/M19-2731
pubmed: 31869833
Shewmon DA. Statement in support of revising the uniform determination of death act and in opposition to a proposed revision. J Med Philos. 2021;Epub ahead of print.
Nguyen D. Does the uniform determination of death act need to be revised? Linacre Q. 2020;87:317–33.
doi: 10.1177/0024363920926018
pubmed: 32699442
pmcid: 7350098
Dalle Ave AL, Bernat JL. Inconsistencies between the criterion and tests for brain death. J Intensive Care Med. 2020;35:772–80.
doi: 10.1177/0885066618784268
pubmed: 29929410
Robbins N, Bernat J. What should we do about the mismatch between legal criteria for death and how brain death is diagnosed? AMA J Ethics. 2020;22:e1038–46.
doi: 10.1001/amajethics.2020.1038
pubmed: 33419505
Lewis A. Contentious ethical and legal aspects of determination of brain death. Semin Neurol. 2018;38:576–82.
doi: 10.1055/s-0038-1668075
pubmed: 30321897
Lewis A, Pope TM. Physician power to declare death by neurologic criteria threatened. Neurocrit Care. 2017;26:446–9.
doi: 10.1007/s12028-017-0375-x
pubmed: 28078616
Lewis A, Bonnie RJ, Pope T, Epstein LG, Greer DM, Kirschen MP, et al. Determination of death by neurologic criteria in the United States: the case for revising the Uniform Determination of Death Act. J Law, Med Ethics. 2019;47:9–24.
doi: 10.1177/1073110519898039
pubmed: 31955689
Jahi McMath and Nailah Winkfield vs. State of California, County of Alameda, Alameda County Department of Public Health, Muntu Davis, MD, MPH, Alameda County Coroner and Medical Examiner, Alameda County Counsel, David Nefouse, Scott Dickey, Alameda County. 2015. p. 3:15-CV–06042.
Re: Guardianship of Hailu. 2015. p. 361 P.3d 5.
Re: Allen Callaway. 2016. p. DG-16–08.
Re: Mirranda Grace Lawson. 2016. p. CL16–2358, City of Richmond Circuit Court.
Alex Pierce v. Loma Linda University Medical Center. 2016.
Israel Stinson v. UC Davis Children’s Hospital. 2016. p. S-CV-0037673.
Uniform Law Commission [Internet]. [cited 2023 Sep 12]. Available from: https://www.uniformlaws.org/aboutulc/overview
Lewis A. The Uniform Determination of Death Act is being revised. Neurocrit Care. 2022;36:335–8.
doi: 10.1007/s12028-021-01439-2
pubmed: 35102538
Truog RD. The uncertain future of the determination of brain death. JAMA. 2023;329:971–2.
doi: 10.1001/jama.2023.1472
pubmed: 36749767
Buscher S. The Uniform Determination of Death Act (UDDA) [Internet]. Am Life Leag. 2023 [cited 2023 Sep 14]. Available from: https://www.all.org/guest-commentary/the-uniform-determination-of-death-act-udda
Marcus A. Doctors and lawyers debate meaning of death as families challenge practices. Wall Str J. 2022.
Mantle L. Not everyone agrees on what determines death. A committee is reviewing whether the definition needs an update. Airtalk with Larry Mantle. 2022.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101.
doi: 10.1191/1478088706qp063oa