The Quest to Revise the Uniform Determination of Death Act: Why We Tried, Why We Failed, and Where We Go from Here

Excerpt

The Uniform Determination of Death Act (UDDA) was written in 1981 to identify the two ways to declare death: death by circulatory-respiratory criteria (DCRC) or brain death/death by neurologic criteria (BD/DNC) [1]. It states, “An individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brainstem, is dead. A determination of death must be made in accordance with accepted medical standards.” Because of the concerns of multidisciplinary experts about the UDDA’s shortcomings, after colleagues with expertise in health law and clinical ethics and I (a neurointensivist) advocated that the Uniform Law Commission (ULC) should revise the UDDA, they empaneled a drafting committee to revise the UDDA in 2021 [2, 3]. I served as an observer on the drafting committee and provided expertise to help guide the discussion. In September 2023, the chair of the drafting committee announced that based on discussion with ULC leadership, work on the UDDA revision was being paused, with the plan to consider resumption in the future only if a revision that can be widely enacted seems feasible [4]. It is important for the neurocritical care community to understand the controversies associated with the content of the UDDA relative to BD/DNC determination, particularly in light of the recent publication of the 2023 BD/DNC guidelines by the American Academy of Neurology (AAN), American Academy of Pediatrics (AAP), Child Neurology Society (CNS), and Society of Critical Care Medicine (SCCM) [5]. In this article, I review why we tried to facilitate revision of the UDDA, why we failed, and where we go from here. …