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Brain Death Contestation: A Scoping Review of Its Incidence and Management
Erica Andrist1,2,3, Andrew Kiragu4, Matthew P Kirschen5,6,7
1Division of Pediatric Critical Care Medicine, C.S. Mott Children's Hospital, Ann Arbor, MI.
Objectives:
To characterize experiences with family contestation of brain death/death by neurologic criteria (BD/DNC) and collate strategies for navigating contested cases.
Data Sources:
PubMed, EMBASE, PsychInfo (EBSCO), Scopus, CINAHL Complete (EBSCO), and Web of Science were searched in consultation with an informationist for terms related to BD/DNC and contestation. The search was updated through January 2025.
Study Selection:
Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews methodology was used. Eligible manuscripts detailed experiences with a contested BD/DNC case(s). Empirical research examining clinical or legal aspects of BD/DNC contestation was eligible, as were professional society guidelines. Two authors independently screened abstracts and full texts. Exclusion criteria included fictionalized cases, case commentaries from authors without direct involvement in the case, publications before 2014, and cases involving pregnant patients.
Data Extraction:
We created a data extraction tool in Covidence to organize and store data.
Data Synthesis:
We screened 10,577 abstracts and identified 26 eligible publications, including eight case reports or case series, 13 research studies, and five professional society guidelines or position papers. Twenty publications came from the United States. The circumstances of BD/DNC contestation varied, ranging from hours-long requests to permit the arrival of family members to protracted litigation. Primary teams consulted multidisciplinary personnel when conflict arose, including palliative care, ethics, social work, legal, hospital chaplaincy, and community religious support. However, few details were provided regarding the perceived utility of these services. Clinicians and hospital personnel desired concrete institutional and legal guidance for addressing contestation.
Conclusions:
Clinicians report encountering BD/DNC contestation. Detailed, flexible management approaches are necessary, but data and recommendations to guide management are lacking. Understanding optimal responses is impeded by the variable circumstances and family actions that are described as contestation. Adequately developing and disseminating management strategies will require consistent definitions and usage of key terms, as well as additional multidisciplinary and participatory scholarship.
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