Nevada leads the nation with use of American Academy of Neurology standards to determine brain death
During the 2017 session of the Nevada State Legislature, The Valley Health System helped make health care history by spearheading efforts to make Nevada the first state in the nation to formally adopt the American Academy of Neurology standards for the determination of brain death. The law becomes effective October 1, 2017 (Nevada Revised Statute 451.007).
Brain death is not the same as being in a coma or a persistent vegetative state (PVS), explained Ellie Powell, RN, the nurse ethicist for The Valley Health System, who also earned a master’s degree in Ethics and Policy Studies. “Brain death means complete and permanent absence of neurological function in the cortex and the brain stem,” said Powell.
An example of brain death is a massive, irreversible brain injury of identifiable cause, which then causes a lack of blood flow to the brain.
While a patient might remain on a ventilator for breathing purposes, receive medications and feel warm to touch after being declared brain dead, it is for organ-sustaining purposes. The “organ-sustaining” language is also a key part of the legislation since the common term has been “life-sustaining,” yet there is no life to sustain. Life-sustaining applies to coma and PVS patients.
“This is important legislation for a patient’s loved ones,” said Karla Perez, Regional Vice President for The Valley Health System. “With American Academy of Neurology standards, there are no doubts. It has been determined through a battery of tests that the brain stem is dead, and the physician can speak with loved ones about next steps.”
Powell played a key role in the entire process, first bringing the issue to the attention of The Valley Health System Ethics Committee for consideration and approval, and then working with Perez, legislators and lobbyists to shepherd it through the legislative session. Assemblyman Mike Sprinkle, the chair of Health and Human Services committee, sponsored the bill. It passed unanimously in the Senate and with only one dissent in the Assembly during the 2017 session.
The Nevada State Legislature bill sparked attention in the bioethics world, including legislative tracking by The Kennedy Institute of Ethics, which was established at Georgetown University in 1971 as a bioethics center, think tank and library.
Prior to the passage of the legislation, Nevada hospitals followed the accepted medical standards of the Uniform Determination of Death Act, which does not specify the elements to be used in making a brain death diagnosis and are not standardized.