Assistant Professor SUNY Upstate Medical University Syracuse, New York
Abstract: The 2023 AAN/AAP/CNS/SCCM Pediatric and Adult Brain Death/Death by Neurologic Criteria (DNC) Consensus Practice Guideline recommends hospitals to establish policies to resolve disagreements regarding the diagnosis of DNC and/or termination of organ support following diagnosis of death. The guidelines support continuation of organ support “providing the family with a reasonable but limited amount of time with the deceased patient.” Policies and laws regarding this “reasonable but limited amount of time” vary across states and hospitals.
We will present a case in which a family contested (though ultimately acquiesced to) a diagnosis of DNC. Following pronouncement, family requested the patient to remain on organ support to allow other family members time to travel to the hospital and adjust to the diagnosis. They declined to change code status to Do Not Resuscitate and declined organ donation. The primary medical team in turn refused to place any further orders on the patient or conduct daily rounds after the patient was declared deceased. This created confusion, uncertainty, and distress for the remaining bedside and consulting providers and compounded the fractious relationship with the family. We will discuss the needs and perspectives of families, bedside providers, and medical team members following diagnosis of DNC, the function and importance of ongoing medical team involvement in the care of these patients, and a consideration of the applicability of different defined types of medical care, (e.g. critical care and post-mortem care) during the time between declaration of DNC and withdrawal of organ support.
Keywords: Death by Neurologic Criteria, Patient/Family Communication, Moral Distress
Learning Objectives:
After participating in this conference, attendees should be able to:
Appraise the intersection and overlap of critical care and post-mortem care which becomes relevant following diagnosis of DNC prior to discontinuation of organ support.
Identify potential needs of family members and other providers which may be met by ongoing critical care, organ support, and involvement of the medical team following diagnosis of DNC.
Anticipate potential conflicts between the medical team, other providers, and family members regarding goals of care following declaration of DNC prior to discontinuation of organ support.
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