The definition, and even the concept, of brain death is undergoing public scrutiny, according to a May 28, 2018, article in The Wall Street Journal. Physicians have long had the authority to declare someone brain dead, which the article defines as "the irreversible cessation of all brain function, including the brain stem, even if heart and lung activity can be maintained by machines." But families are beginning to challenge this determination regarding their loved ones. Stories like that of a 17-year-old girl in California who was declared brain dead in 2013 following complications from surgery, but now demonstrates minimal brain activity, have spread across social media and helped fuel this change in thinking. The American Academy of Neurology established criteria for determining brain death in adults and encourages all doctors and hospitals to follow them. However, variability still exists in how doctors administer tests for brain death, how long they wait to test the brain stem, and even what kind of physician is qualified to make this determination. Public trust has eroded as a result. Some doctors are thus encouraging patients' families to observe the tests they conduct to determine brain death. The Neurological Care Society has created an online Brain Death Toolkit that includes sample policies for hospitals to adapt and a list of frequently asked questions from the public. At one medical school, students must take a 90-minute brain-death training session that discusses the medical and legal issues and also includes role playing, with one student playing the spouse of a patient diagnosed as brain dead. One hospital has created a brain-death support team composed of experts to help other clinicians make the correct diagnoses. But improving diagnoses can go only so far. One hurdle is that families and providers may have different definitions of death. For example, the article said, how does one explain to parents that their child, who "has a beating heart and skin that is warm to the touch," is not alive? Families may also reject a brain-death diagnosis on religious grounds.

HRC Recommends: Healthcare facilities should have written protocols, which the neurospecialty services develop and the medical staff review, governing the procedures for determination of brain death. Healthcare workers should be knowledgeable about what constitutes brain death, as healthcare worker confusion on this matter may in turn contribute to family confusion. The tests performed for each patient and the outcomes should be documented in the patient's medical chart for later review.