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Incoherence in the Brain Death Guideline Regarding Brain Blood Flow Testing: Lessons from the Much-Publicized Case of
Doyen Nguyen1, Christine M Zainer2
1Institute of Bioethics, Universidade Católica Portuguesa, Lisboa, Portugal.
The Linacre Quarterly
|February 7, 2025
Summary
A traumatic brain injury patient declared brain-dead surprisingly recovered, highlighting risks of false declarations. Cognitive-motor dissociation and flawed brain blood flow tests can lead to misdiagnoses of death.
Area of Science:
- Neurology
- Forensic Medicine
Background:
- A patient, Zack Dunlap, was declared brain-dead after a severe traumatic brain injury based on clinical criteria and scintigraphy.
- Organ donation preparations were underway when the patient exhibited purposeful movement, indicating potential misdiagnosis.
Purpose of the Study:
- To critically review the case of Zack Dunlap and analyze the diagnostic criteria for brain death.
- To identify potential flaws in the American Academy of Neurology guideline for determining brain death, specifically regarding brain blood flow scintigraphy.
- To discuss the implications of cognitive-motor dissociation in brain death declarations.
Main Methods:
- Case study review of Zack Dunlap's medical records.
- Critical analysis of the American Academy of Neurology's brain death guideline algorithm.
- Examination of technetium-99m diethylene-triamine-pentaacetate scintigraphy interpretation.
Main Results:
- The patient, initially declared brain-dead, showed signs of neurological recovery and returned to a normal life.
- A review revealed a logical flaw in the guideline's algorithm concerning brain blood flow scintigraphy.
- The patient reported awareness and emotional response while in a comatose state, consistent with cognitive-motor dissociation.
Conclusions:
- The case of Zack Dunlap demonstrates that cognitive-motor dissociation can occur in patients declared brain-dead.
- Flaws in brain blood flow scintigraphy interpretation within the guideline algorithm pose a risk of false-positive death declarations.
- Re-evaluation of brain death diagnostic protocols is necessary to prevent potentially fatal errors.
