Death by neurologic criteria (DNC) (also known as brain death) is legally equivalent to death by cardiopulmonary criteria. Patients who are declared DNC are candidates for organ donation. It is often difficult to obtain consent for organ donation from a brain dead patient's family. Tessmer et al1 found that if a patient endorsed desire for organ donation, 80% of people would agree to donation if they were told their family member died, but only 63% would agree if they were told their family member was brain dead. This discrepancy appears to be related to poor public understanding that DNC is irreversible and is functionally synonymous with cardiopulmonary death.
The media plays an important role in educating the public on medical topics and can impact public behavior and decision-making in situations, such as requests for organ donation.2 In a review of 519 articles in American media that contained the words “brain dead” or “brain death,” Daoust and Racine3 found that a definition of brain death was provided in only 2.7% of articles, 50% of which contained incomplete definitions. Legal issues were addressed in only 7.3% of articles. Organ donation after DNC was discussed in only 21.2% of articles. Journalists often struggle with disseminating medical information due to lack of time, knowledge, space, and sources, but the public frequently relies on stories in the media to provide them with education on medical topics.2
When highly publicized cases about brain dead patients, such as Jahi McMath and Marlise Muñoz,4 are in the news, it is important that expert sources, such as physicians, ethicists, and transplant coordinators, communicate with the public via reporters to provide them with medicolegal facts about brain death. To facilitate this communication, it would be beneficial for professional societies to provide up-to-date background information on brain death online and to reach out to the media when brain death is in the headlines.2 This would help to circulate reliable, detailed, medically, and legally accurate information to the public at a propitious time for education on brain death to occur. Specific things to emphasize include: (1) medical criteria for brain death including mention of the prerequisites for evaluation, the clinical examination findings, the apnea test findings, and the use of ancillary tests if needed as described by the American Academy of Neurology; (2) clarification of the distinction between brain death, a persistent vegetative state, a minimally conscious state, and a coma; (3) the fact that brain death is legally equivalent to cardiopulmonary death and that organ support is routinely discontinued after declaration of brain death unless organ donation is planned5; and (4) the fact that some states have accommodation laws that address religious or moral objection to declaration of death by neurologic criteria. Provision of a clear explanation of these facts to journalists would surely enhance the caliber of reporting on brain death in the media. Hopefully, this would lead to improved public understanding of the meaning of brain death and subsequently lead to increased rates of organ donation after DNC.
1. Tessmer CS, da Silva AR, Barcellos FC, et al. Do people accept brain death as death? A study in Brazil. Prog Transplant
. 2007; 17: 63–67.
2. Larsson A, Oxman AD, Carling C, et al. Medical messages in the media—barriers and solutions to improving medical journalism. Health Expect
. 2003; 6: 323–331.
3. Daoust A, Racine E. Depictions of “brain death” in the media: medical and ethical implications. J Med Ethics
. 2014; 40: 253–259.
4. Bernat JL. Whither brain death? Am J Bioeth
. 2014; 14: 3–8.
5. Wijdicks EFM, Varelas PN, Gronseth GS, et al. Evidence-based guideline update: determining brain death in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology
. 2010; 74: 1911–1918.