Response to Machado et al. re: Jahi McMath

Excerpt

I appreciate the interest of Machado et al. in my recent article on reconciling the case of Jahi McMath [1]. Based on review of an electroencephalography (EEG), magnetic resonance imaging (MRI), and heart rate variability analysis, Machado et al. conclude that Jahi was in “a state of disorder of consciousness, not previously described…placed between BD and Coma/VS/UWS” [2]. In discussing states of consciousness, as in any discussion, it is imperative that a universal lexicon be employed in order to ensure that the verbiage utilized is comprehended in the same way by all parties. With respect to the definition of “brain death,” the American Academy of Neurology (AAN), American Academy of Pediatrics, American College of Chest Physicians, American Neurological Association, Child Neurology Society, and Neurocritical Care Society support the characterization that “brain death” is an “irreversible loss of consciousness and brainstem function leading to the inability to breathe independent of artificial support” with the understanding that (1) “determination of death is based on loss of clinical function of the heart and lungs or the brain, and the demise of every neuron or myocardial cell is not required” and (2) the accepted medical criteria for determination of brain death are the 2010 AAN guidelines for determination of brain death in adults and the 2011 AAP/CNS/SCCM guidelines for determination of brain death in pediatric persons [3]. Heart rate variability (either at the time of or months after a brain death determination) is not mentioned in the adult or pediatric brain death guidelines [4, 5]. …