Hostname: page-component-586b7cd67f-tf8b9 Total loading time: 0 Render date: 2024-11-29T10:27:04.791Z Has data issue: false hasContentIssue false
  • English
  • Français

Brain Death Revisited: The Case for a National Standard

Published online by Cambridge University Press:  01 January 2021

Eun-Kyoung Choi ,
Valita Fredland ,
Carla Zachodni ,
J. Eugene Lammers ,
Patricia Bledsoe  and
Paul R. Helft
Get access Rights & Permissions [Opens in a new window]

Extract

The concept of brain death evolved because advancements in medical science permitted unprecedented artificial maintenance of vital body functions by external means. Although the concept of brain death is accepted clinically, ethically, and legally in the United States, there is no national standard for the determination of brain death. There is evidence that variability and inconsistency in the process of determining brain death exist both in clinical settings and in State statutes. Several studies demonstrate that medical personnel determine brain death in variable ways, and have variable understandings of the definition of brain death. The declaration of death has significant legal consequences such as probate proceedings and liability issues for wrongful death. Inconsistencies in the determination of death may therefore be medically, ethically, and legally problematic.

Type
Independent
Information
Journal of Law, Medicine & Ethics , Volume 36 , Issue 4 , Winter 2008 , pp. 824 - 836
Copyright
Copyright © American Society of Law, Medicine and Ethics 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Hoch, D. B., “Brain Death: A Diagnostic Dilemma,” The Journal of Nuclear Medicine 33, no. 12 (1992): 2211–2213, at 2212; Halevy, A. and Brody, B., “Brain Death: Reconciling Definitions, Criteria, and Trusts,” Annals of Internal Medicine 119, no. 6 (1993): 519-525, at 519; Randell, T., “Medical and Legal Considerations of Brain Death,” Acta Anesthesiologica Scandinavica 48 (2004): 139-144, at 139; Baron, L., Shemie, S. D., Teitelbaum, J., Doig, C. J., “Brief Review: History, Concept and Controversies in the Neurological Determination of Death,” Canadian Journal of Anesthesia 53, no. 6 (2006): 602-608, at 603.Google Scholar
Wijdicks, E. F. M., “The Clinical Criteria of Brain Death Throughout the World: Why Has It Come to This?” Canadian Journal of Anesthesia 53, no. 6 (2006): 540–543, at 540 [hereinafter Clinical Criteria]; Powner, D. J., Hernandez, M., Rives, T.E., “Variability among Hospital Policies for Determining Brain Death in Adults,” Critical Care Medicine 32, no.6 (2004): 1284-1288; Wijdicks, E. F. M., “Brain Death Worldwide: Accepted Fact but No Global Consensus in Diagnostic Criteria,” Neurology 58, no. 1 (2002): 20-25, at 24 [hereinafter Brain Death Worldwide].CrossRefGoogle Scholar
See Wijdicks (Clinical Criteria), supra note 2, at 540; Wijdicks, , (Brain Death Worldwide), supra note 2, at 23; Wang, M. Y., Wallace, P. and Gruen, P. J., “Brain Death Documentation: Analysis and Issues,” Neurosurgery 51, no. 3 (2002): 731–736, at 732–3; Alabama: Ala. Code 1975 § 22-31-1 (2000); Alaska: Alaska Stat. § 09.68.120 (West 1995); Arizona: State v. Fierro, 603 P.2d 74 (Ariz. 1979); Arkansas: Ark. Code. Ann. § 20-17-101 (West 1985); California: Cal. Health & Safety Code § 7180 (West 1982); Colorado: Colo. Rev. Stat. Ann. § 12-36-136 (West 1981); Connecticut: Conn. Gen. Stat. Ann. § 19a- 279h (West 1988); Delaware: 24 Del. C. § 1760 (West 2005); District of Columbia: D.C. Code § 7–601 (1982); Florida: Fla. Stat. Ann. § 382.009 (West 1987); Georgia: Ga. Code Ann., § 31-10-16 (West 1992); Hawaii: Haw. Rev. Stat. § 327C-1 (West 1998); Idaho: Idaho Code § 54–1819 (West 1981); Illinois: 755 Ill. Comp. Stat. Ann. 50/1–10 (West 2004); Indiana: Ind. Code Ann. 1-1-4-3 (West 1986); Iowa: Iowa Code Ann. § 702.8 (West 2001); Kansas: Kan. Stat. Ann. § 77–205 (West 1984); Kentucky: Ky. Rev. Stat. Ann. § 446.400 (West 1986); Louisiana: La. Rev. Stat. Ann. 9:111 (2001); Maine: Me. Rev. Stat. Ann. tit. 22, § 2811 (1983); Massachusetts: Commonwealth v. Golston, 366 N.E.2d 744; Maryland: MD. Code Ann., Code, Health – Gen. § 5–202 (West 1998); Michigan: Mich. Comp. Laws. Ann. § 333.1033 (West 1992); Minnesota: Minn. Stat. Ann. § 145.135 (West 1989); Mississippi: Miss. Code Ann. § 41-36-3 (West 1981); Missouri: Mo. Ann. Stat. § 194.005 (West 1982); Montana: Mont. Code Ann. § 50-22-101 (1983); Nebraska: Neb. Rev. Stat. § 71–7202 (1992); Nevada: Nev. Rev. Stat. Ann. § 451.007 (West 1985); New Hampshire: N. H. Rev. Stat. Ann. § 141-D:2 (1987); New Jersey: N.J. Stat. Ann. § 26:6A-3 (West 1991); New Mexico: N.M. Stat. Ann. § 12-2-4 (West 2007): New York: N.Y. Comp. Codes R. & Regs. tit. 10, § 400.16 (1987); North Carolina: N.C. Gen. Stat. Ann. § 90–323 (West 1979); North Dakota: N.D. Cent. Code § 23–06.3–01 (West 1989); Ohio: Ohio Rev. Code Ann. § 2108.30 (West 1981); Oklahoma: Okla. Stat. Ann. tit. 63, § 3122 (West 1986); Oregon: OR. Rev. Stat. Ann. § 432.300 (West 1997); Pennsylvania: 35 Pa. Stat. Ann. § 10203 (West 1982); Rhode Island: R.I. Gen. Laws 1956, § 23-4-16 (1982); South Carolina: S.C. Code Ann. § 44-43-460 (2006); South Dakota: S.D. Codified Laws § 34-25-18.1(1990); Tennessee: Tenn. Code Ann. § 68-3-501 (West 1982); Texas: Tex. Health & Safety Code Ann. § 671.001 (Vernon 1995); Utah: Utah. Code Ann. § 26-34-2 (West 2007); Vermont: Vt. Stat. Ann. tit. 18, § 5218 (West 1981); Virginia: Va. Code Ann. § 54.1–2972 (West 2004); Washington: In re Welfare of Bowman, 617 P. 2d 731 (Wash. 1980); West Virginia: W.Va. Code Ann. § 16-10-1 (West 1989); Wisconsin: Wis. Stat. Ann. § 146.71 (Wet 1982); Wyoming: Wyo. Stat. Ann. § 35-19-101 (1985) [hereafter State's statute and cases, State statutes if only referring to the statutes, State cases if only referring to the cases].Google Scholar
Mejia, R. E. and Pollack, M. M., “Variability in Brain Death Determination Practices in Children,” JAMA 274, no. 7 (1995): 550–553, at 551–552; Youngner, S. J., Landefeld, C. S. and Coulton, C. J., Juknialis, B. W. and Leary, M., “‘Brain Death’ and Organ Retrieval: A Cross-sectional Survey of Knowledge and Concepts among Health Professionals,” JAMA 261, no. 15 (1989): 2205-2210, at 2208-2209; see Wang, et al., supra note 3, at 732–733.CrossRefGoogle Scholar
Jeffrey, S., “Brain Death Guidelines Vary Widely at Top US Neurological Hospitals,” available at <http://www.medscape.com/viewarticle/564125> (last visited October 6, 2008); see Youngner, et al., supra note 4, at 2208–2209.+(last+visited+October+6,+2008);+see+Youngner,+et+al.,+supra+note+4,+at+2208–2209.>Google Scholar
See Baron, et al., supra note 1, at 607.Google Scholar
Id.Google Scholar
Kulkarni, S. and Cronin, D. C. II, “Ethical Tensions in Solid Organtransplantation: The Price of Success,” World Journal of Gastroenterology 12, no. 20 (2006): 3259–3264, at 3261.Google Scholar
The Organ Procurement and Transplantation Network, available at <http://www.optn.org/about/donation/whoCanBeA-Donor.asp> (last visited October 6, 2008).+(last+visited+October+6,+2008).>Google Scholar
See Kulkarni, and Cronin, , supra note 8, at 3259.Google Scholar
The United Network for Organ Sharing, available at <http://www.unos.org> (last visited October 6, 2008).+(last+visited+October+6,+2008).>Google Scholar
The Organ Procurement and Transplantation Network, available at <http://www.optn.org/latestData/rptData.asp> (last visited October 6, 2008).+(last+visited+October+6,+2008).>Google Scholar
Lazar, N. M., Shemie, S., Webster, G. C. and Dickens, B. M., “Bioethics for Clinicians: 24 Brain Deaths,” Canadian Medical Association Journal 164 no. 6 (2001): 833–836, at 834.Google Scholar
See Wijdicks (Clinical Criteria), supra note 2, at 541; Powner, et al., supra note 2, at 1287; Wijdicks, (Brain Death Worldwide), supra note 2, at 24.Google Scholar
In re Quinlan, 355 A.2d 647 (N. J. 1976).Google Scholar
See Halevy, and Brody, , supra note 1, at 519.Google Scholar
Smith v. Smith, 317 S.W.2d 275 (Ark. 1958).CrossRefGoogle Scholar
Truog, R. D. and Robinson, W. M., “Role of Brain Death and The Dead-Donor Rule in the Ethics of Organ Transplantation,” Critical Care Medicine 31, no. 9 (2003): 2391–2396, at 2391.CrossRefGoogle Scholar
Id.Google Scholar
See Randell, , supra note 1, at 140.Google Scholar
Id.Google Scholar
See State statutes and cases, supra note 3.Google Scholar
See Wang, et al., supra note 3 at 732.Google Scholar
Uniform Determination of Death Act 1980, prefatory note. (West 1980)Google Scholar
Uniform Determination of Death Act 1980. (West 1980)Google Scholar
See Wang, et al., supra note 3, at 732.Google Scholar
See State's statutes, supra note 3.Google Scholar
See State's cases, supra note 3.Google Scholar
Wijdicks, E. F. M., “The Diagnosis of Brain Death,” New England Journal of Medicine 344, no. 16 (2001): 1215–1221, at 1215.CrossRefGoogle Scholar
The Quality Standards Subcommittee of the American Academy of Neurology, “Practice Parameters for Determining Brain Death in Adults,” Neurology 45, no. 5 (1995): 1012–1014 [hereafter Quality Standards Subcommittee].CrossRefGoogle Scholar
See Wijdicks, , supra note 29, at 1216.Google Scholar
See Wijdicks, , Clinical Criteria, supra note 2, at 540.Google Scholar
Shewmom, D. A., “Chronic ‘Brain Death’: Meta-analysis and Conceptiual Consequences,” Neurology 51 (1998): 1538–1545; Halevy, A. and Brody, B., “Brain Death: Reconciling Definitions, Criteria, and Tests,” Annals of Internal Medicine 119 (1993): 519-255; Truog, R. D., “Is It Time to Abandon Brain Death?” Hastings Center Report 27, no. 1 (1997): 29-37.CrossRefGoogle Scholar
Chiong, W., “Brain Death without Definitions,” Hastings Center Report 35, no. 6 (2005): 20–30.CrossRefGoogle Scholar
See Randell, , supra note 1, at 140.Google Scholar
See Baron, et al., supra note 1, at 603.Google Scholar
See Wijdicks, , supra note 29, at 1215.Google Scholar
Id.Google Scholar
See Quality Standards Subcommittee, supra note 32.Google Scholar
Id.Google Scholar
See Wijdicks, , supra note 29.Google Scholar
Id.Google Scholar
Id., at 1216.Google Scholar
See Mejia, and Pollack, , supra note 4, at 550.Google Scholar
See Randell, , supra note 1, at 142; Mejia, and Pollack, , supra note 4, at 550.Google Scholar
See Mejia, and Pollack, , supra note 4, at 550.Google Scholar
See Randell, , supra note 1, at 140; Quality Standards Subcommittee, supra note 32, at 1012; Canadian Neurocritical Care Group, “Guidelines for The Diagnosis for Brain Death,” Canadian Journal of Neurological Sciences 26, no. 1 (1999): 64–66, at 64.Google Scholar
See Quality Standards Subcommittee, supra note 31, at 1012–1013;Canadian Neurocritical Care Group, supra note 46, at 65.Google Scholar
See Wijdicks, , supra note 29, at 1220; Quality Standards Subcommittee, supra note 32, at 1013.Google Scholar
Id.Google Scholar
See State's statutes, supra note 3.Google Scholar
See Wijdicks, , Clinical Criteria, supra note 2, at 540; Wijdicks, (Brain Death Worldwide), supra note 2, at 23; Powner, et al., supra note 2, at 1285; Mejia, and Pollack, , supra note 4, at 551; Wang, et al., supra note 3, at 732–733; Jeffrey, , supra note 5, at 1; Chang, M. Y., McBride, L. A. and Ferguson, M. A., “Variability in Brain Death Declaration Practices in Pediatric Head Trauma Patients,” Pediatric Neurosurgery 39 (2003): 7–9, at 9.Google Scholar
See Wijdicks (Brain Death Worldwide), supra note 2, at 21.Google Scholar
See State's statutes, supra note 3.Google Scholar
Id.Google Scholar
Fla. Stat. Ann. § 382.009 (West 1987)Google Scholar
N.Y. Comp. Codes R. & Regs. tit. 10, § 400.16 (e)(3) (1987); Matter of hong Island Jewish Medical Center, 641 N.Y.S.2d 989 (N.Y. App. Div. 1996); Matter of Conroy, 486 A.2d 1209 (N.J. 1985).Google Scholar
Va. Code Ann. § 54.1–2972 (West 2004)Google Scholar
Alaska Stat. § 09.68.120 (West 1995); Ga. Code Ann., § 31-10-16 (West 1992); Mich. Comp. Laws. Ann. § 333.1033 (West 1992)Google Scholar
Conn. Gen. Stat. Ann. § 19a-279h (West 1988); Fla. Stat. Ann. § 382.009 (West 1987); Iowa Code Ann. § 702.8 (West 2001); Kentucky: Ky. Rev. Stat. Ann. § 446.400 (West 1986); Va. Code Ann. § 54.1–2972 (West 2004)Google Scholar
Fla. Stat. Ann. § 382.009 (West 1987)Google Scholar
Va. Code Ann. § 54.1–2972 (West 2004)Google Scholar
Lovato v. Dist.Court of Tenth Judicial Dist, 601 P.2d 1072 (Colo. 1979); Dority v. Superior Court, 145 Cal. App. 3d 273 (Cal. Ct. App. 1983); In Re Haymer, 450 N.E.2d 940 (Ill. App. Ct. 1983)Google Scholar
Capron, A. M., “Brain Death: Well Settled Yet Still Unresolved,” New England Journal of Medicine 344, no. 16 (2001): 1244–1246, at 1244–1245 (“The term ‘brain death’ has become so familiar that it is not likely to be replaced by a more precise and less confusing term, such as ‘brain-based determination of death.’ Nonetheless, physicians who rely on diagnostic criteria of the sort set forth by Wijdicks ought to recognize that the language they use not only reflects but also sows confusion. Since ‘brain dead’ patients show such traditional signs of life warn, moist skin, a pulse, and breathing, it is not surprising that many people seem to think that ‘brain dead’ is a separate type of death that occurs before ‘real’ death. This confusion is reinforced when hospital personnel state — and journalists repeat — that ‘life support’ is being removed from such patients.”)CrossRefGoogle Scholar
Dority, 145 Cal. App. 3d at 279.Google Scholar
N.J. Statues Ann. 52:17B-88.1 through 88.6; N.Y. Public Health Law 4210-c(1) et seq.Google Scholar
See Wang, et al., supra note 3, at 732–733; Mejia, and Pollack, , supra note 4, at 551–552; Youngner, et al., supra note 4, at 2208–2209; Burck, R., Anderson-Shaw, L., Sheldon, M. and Egan, E. A., “The Clinical Response to Brain Death: A Policy Proposal,” JONA's Healthcare haw, Ethics, and Regulation 8, no. 2 (2006): 53–59, at 55.Google Scholar
See Youngner, et al., supra note 4 at 2208.Google Scholar
See Halevy, and Brody, , supra note 1, at 520–521; Ala, T. A., “A Case Meeting Clinical Brain Death Criteria with Residual Cerebral Perfusion,” American Journal of Neuroradiology 27 (2006): 1805–1806, at 1805; Saposnik, G., Bueri, J. A., Maurino, J., Saizar, R. and Garretto, N. S., “Spontaneous and Reflex Movements in Brain Death,” Neurology 54 (2000): 221–224, at 221.Google Scholar
See Ala, , supra note 69, at 1806, 1882; Saposnik, et al., supra note 69, at 221.Google Scholar
Id.Google Scholar
See Saposnik, et al., supra note 69, at 222.Google Scholar
Id.Google Scholar
Id.Google Scholar
Saposnik, G., Maurino, J. and Bueri, J., “Movements in Brain Death,” European Journal of Neurology 8 (2001): 209–213, at 209.CrossRefGoogle Scholar
See Quality Standards Subcommittee, supra note 30, at 1013; Saposnik, et al., supra note 75, at 212.Google Scholar
See Halevy, and Brody, , supra note 1, at 520.Google Scholar
Black, P. M. and Zervas, N. T., “Declaration of Brain Death in Neurosurgical and Neurological Practice,” Neurosurgery 15 (1984): 170–174, at 170.CrossRefGoogle Scholar
Id.Google Scholar
Id.Google Scholar
Id., at 171.Google Scholar
Id., at 171–172.Google Scholar
Id., at 172.Google Scholar
Id., at 173.Google Scholar
Id., at 171.Google Scholar
Id.Google Scholar
Id.Google Scholar
See Wijdicks, (Brain Death Worldwide), supra note 2, at 23; Powner, et al., supra note 2, at 1285; Mejia, and Pollack, , supra note 4, at 551; Wang, et al., supra note 3, at 732–733; Jeffrey, , supra note 5, at 1; Chang, et al., supra note 52, at 79.Google Scholar
See Powner, et al., supra note 2, at 1284.Google Scholar
Id., at 1285.Google Scholar
See Powner et al, supra note 2, at 1285; Mejia, and Pollack, , supra note 4, at 551; Jeffrey, , supra note 5, at 1.Google Scholar
See Wang, et al., supra note 3, at 732–733.Google Scholar
See Powner et al, supra note 2, at 1284–1285.Google Scholar
Id., at 1285.Google Scholar
Id., at 1285–1287.Google Scholar
Id.Google Scholar
Id., at 1285.Google Scholar
Id.Google Scholar
Id.Google Scholar
Id.Google Scholar
Id.Google Scholar
Id., at 1285–1287.Google Scholar
Id., at 1285.Google Scholar
Id., at 1286.Google Scholar
Id.Google Scholar
Id.Google Scholar
Id.Google Scholar
Id.Google Scholar
Id., at 1287.Google Scholar
Id.Google Scholar
See Jeffrey, , supra note 5, at 1.Google Scholar
Id.Google Scholar
Id., at 1–2.Google Scholar
See Wang, et al., supra note 3, at 732.Google Scholar
Id., at 732–733.Google Scholar
Id., at 734.Google Scholar
Id.Google Scholar
See Mejia, and Pollack, , supra note 4, at 550–552.Google Scholar
Id., at 551–552.Google Scholar
Id.Google Scholar
See Chang, et al., supra note 52, at 8.Google Scholar
Izac, S. M., “Quality Assurance in Determinations of Brain Death,” American Journal of Electroneurodiagnostic Technology 44, no. 3 (2004): 159–171, at 161.Google Scholar
See Lazar, et al., supra note 12, at 834.Google Scholar
Janus v. Metro. Life Ins. Co., 482 N.E.2d 418 (Ill. App. 1985).Google Scholar
See Baron, et al., supra note 1, at 607.Google Scholar
Lovato, 601 P.2d 1072; In re Haymer, 450 N.E.2d 940.Google Scholar
Dority, 145 Cal. App. 3d 273.Google Scholar
Nethery v. State, 692 S.W.2d 686 (Tex. Crim. App. 1985).Google Scholar
Ewing v. State, 719 N.E.2d 1221 (Ind. 1999); People v. hai, 131 A.D.2d 592 (N.Y. App. Div. 1987); State v. Guess, 715 A.2d 643 (Conn. 1998); State v. Olson, 435 N.W.2d 530 (Minn. 1989); United State v. Market, 65 M.J. 677 (N-M. Ct. Crim. App. 2007)Google Scholar
In re Haymer, 450 N.E.2d at 945 n. 9.Google Scholar
United States v. Gomez, 15 M.J. 954 (A.C.M.R. 1983)Google Scholar
Id., at 959.Google Scholar
See Wijdicks, , Clinical Criteria, supra note 2 at 540.Google Scholar
See State's statutes, supra note 3.Google Scholar
See Burke, et al., supra note 67, at 55.Google Scholar
See Kulkarni, and Cronin, , supra note 8, at 3261; Lazar, et al., supra note 12 at 834; see also McKinley, J., “Surgeon Accused of Speeding a Death to Get Organs,” New York Times, February 27, 2008, available at <http://www.nytimes.com/2008/02/27/us/27transplant.html?_r=1&oref=slogin> (last visited October 6, 2008).+(last+visited+October+6,+2008).>Google Scholar
Siminoff, L. A., Burant, C. and Younger, S., “Death and Organ Procurement: Public Beliefs and Attitudes,” Social Science & Medicine 59, no. 11 (2004): 2325–2334, at 2330.Google Scholar
See Saposnik, et al., supra note 75, at 210.Google Scholar
Capron, A. M., “Brain Death — Well Settled Yet Still Unresolved,” New England Journal of Medicine 344, no. 16 (2001): 1244–1246, at 1245.CrossRefGoogle Scholar
See Kulkarni, and Cronin, , supra note 8, at 3260 (Extended criteria for organ donor include the donors whose characteristics are not considered to be ideal or standard.); Koh, Howard et al., “A Statewide Public Health Approach to Improving Organ Donation: The Massachusetts Organ Donation Initiative,” American Journal of Public Health 97, no. 1 (2007): 30–36 (Massachusetts Organ Donation Initiative is to form a unique partnership among organ procurement organizations, major teaching hospitals, and the state's department of public health to increase organ supply by focusing on reaching families during a time of critical decision-making.); Salim, A., “The Effect of a Protocol of Aggressive Donor Management: Implications for the National Organ Donor Shortage,” Journal of Trauma, Injury, Infection and Critical Care 61, no. 2 (2006): 429-435 (In other words, the characteristics include advanced age, hypertension, and abnormal organ donor function. Aggressive donor management intends to increase organ supply by identifying potential donors in early stage.)Google Scholar
Siminoff, L. A., Mercer, M. B., Graham, G. and Burant, C., “The Reasons Families Donate Organs for Transplantation: Implications for Policy and Practice,” The Journal of Trauma, Injury, Infection, and Critical Care 62, no. 4 (2006): 969–978, at 973.CrossRefGoogle Scholar
See Powner, et al., supra note 2, at 1284.Google Scholar
See Baron, et al., supra note 1, at 606.Google Scholar
Quality Standards Subcommittee, supra note 30, at 1012.Google Scholar
See Randell, , supra note 1, at 140.Google Scholar
Id., at 143.Google Scholar
Id., at 141.Google Scholar
Id., at 141; see Wijdicks, , supra note 29, at 1220; Quality Standards Subcommittee, supra note 30, at 1013.Google Scholar
Quality Standards Subcommittee, supra note 30, at 1013.Google Scholar
Young, G. Bryan, Shemie, S. D., Doig, C. J. and Teitelbaum, J., “Brief Review: The Role of Ancillary Tests in the Neurological Determination of Death,” Canadian Journal of Anesthesia 53, no. 6 (2006): 620–627 at 621.CrossRefGoogle Scholar
Id., at 625.Google Scholar
See Quality Standards Subcommittee, supra note 30, at 1013.Google Scholar
Id.Google Scholar
Id.Google Scholar
See Halevy, and Brody, , supra note 1, at 520–521; Ala, , supra note 69, at 1806; Saposnik, et al., supra note 69, at 221; Wijdicks, E. F. M., Manno, E. M. and Holets, S. R., “Ventilator Self-Cycling May Falsely Suggest Patient Effort during Brain Death Determination,” Neurology 65, no. 5 (2005): 774.Google Scholar
See Quality Standards Subcommittee, supra note 30, at 1013.Google Scholar
Flowers, W. M. and Patel, B. R., “Accuracy of Clinical Evaluation in the Determination of Brain Death,” Southern Medical Journal 93 no. 2 (2000): 203–206, at 206.Google Scholar
Id.Google Scholar
See Powner et al, supra note 2, at 1285.Google Scholar
Uniform Anatomical Gift Act (West 1987).Google Scholar
See Wijdicks (Brain Death Worldwide), supra note, 2, at 21.Google Scholar
See Wijdicks, (Clinical Criteria), supra note 2, at 541; Wang, et al., supra note 3, at 736.Google Scholar
The Joint Commission on Accreditation of Healthcare Organizations, available at <http://www.jointcommission.org/CertificationPrograms/TransplantCenterCertification/> (last visited October 6, 2008).+(last+visited+October+6,+2008).>Google Scholar