From LifeSiteNews

By Heidi Klessig, M.D.

The Uniform Determination of Death Act (UDDA) states that there must be an irreversible cessation of all functions of the entire brain for a declaration of brain death. The way doctors currently diagnose brain death does not comply with the law under the UDDA.

North Carolina Central University football player Terrance Howard died recently after a car accident reportedly left him “brain dead.” But his family disputed this diagnosis and requested that their son be transferred to another facility for treatment of his brain injury, leading to conflict with Terrance’s doctors and hospital. According to News One, his parents claimed that Atrium Health Carolinas Medical Center wanted to kill their son for his organs, and accused doctors of snickering and laughing while refusing to help him. His father, Anthony Allen, told News One that the hospital removed Terrance from life support against his family’s wishes and forcibly ejected his family from his room. The family posted videos on social media of apparent police officers entering Terrance’s hospital room, and said that the hospital threatened them with criminal action for trespassing.

If these allegations are true, the Howard family has every right to be outraged at the disrespectful treatment they received at Atrium Health. Especially now, as the legitimacy of brain death is coming under increasing scrutiny, it is outrageous that hospitals and doctors continue being so heavy-handed. The National Catholic Bioethics Center (NCBC), formerly a staunch supporter of “brain death,” released a statement in April 2024, saying:

Events in the last several months have revealed a decisive breakdown in a shared understanding of brain death (death by neurological criteria) which has been critical in shaping the ethical practice of organ transplantation. At stake now is whether clinicians, potential organ donors, and society can agree on what it means to be dead before vital organs are procured.

The NCBC statement was prompted by the newest brain death guideline which explicitly allows people with partial brain function to be declared brain dead. But the Uniform Determination of Death Act (UDDA) states that there must be an irreversible cessation of all functions of the entire brain for a declaration of brain death. The way doctors currently diagnose brain death does not comply with the law under the UDDA.

Terrance Howard’s story is reminiscent of the mistreatment of another Black teenager, Jahi McMath. In 2013, Jahi was a quiet, cautious teenager with sleep apnea who underwent a tonsillectomy and palate reconstruction to improve her airflow while sleeping. An hour after the surgery, she started spitting up blood. Her parents requested repeatedly to see a doctor without success. Her mother, Nailah Winkfield, said, “No one was listening to us, and I can’t prove it, but I really feel in my heart: if Jahi was a little white girl, I feel we would have gotten a little more help and attention.”

Jahi continued to bleed until she had a cardiac arrest just after midnight. She was pulseless for ten minutes during her “code blue” resuscitation. Two days later, her electroencephalogram (EEG) was flatline, and it was clear that Jahi had suffered a severe brain injury which was worsening. But rather than treating these findings aggressively, her doctors proceeded toward a diagnosis of brain death. Three days after her surgery, her parents were informed that their daughter was “dead” and that Jahi could now become an organ donor. The family was stunned. How could Jahi be dead? She was warm, she was moving occasionally, and her heart was still beating. As a Christian, Nailah believed her daughter’s spirit remained in her body as long as her heart continued to beat. While the family sought medical and legal assistance, Children’s Hospital Oakland doubled down, refusing to feed Jahi for three weeks. The hospital finally agreed to release Jahi to the county coroner for a death certificate, following which her family would be responsible for her.

On January 3, 2014, Jahi received a death certificate from California, listing her cause of death as “Pending Investigation.” Why was the hospital so adamant about insisting Jahi was dead, even to the point of issuing a death certificate? Possibly because California’s Medical Injury Compensation Reform Act limits noneconomic damages to $250,000. If Jahi was “dead,” the hospital and its malpractice insurer would only be liable for $250,000. But if Jahi was alive, there would be no limit to the amount her family could claim for her ongoing care.

After Jahi was transferred to New Jersey, the only US state with a religious exemption to a diagnosis of brain death, she began to improve. After noticing that Jahi’s heart rate would decrease at the sound of her mother’s voice, the family began asking her to respond to commands, and videoed her correct responses. Jahi went through puberty and began to menstruate — something not seen in corpses! By August 2014 she was stable enough to move into her mother’s apartment for continuing care. Subsequently Jahi was examined by two neurologists (Dr. Calixto Machado and Dr. D. Alan Shewmon) who found that she had definitely improved: she no longer met the criteria for brain death and was in a minimally conscious state. Jahi continued responding to her family in a meaningful way until her death in June 2018 from complications of liver failure.

How could Jahi McMath, who was declared brain dead by three doctors, who failed three apnea tests, and who had four flatline EEGs and a radioisotope scan showing no intracranial blood flow, go on to recover neurologic function? Very likely, due to a condition called Global Ischemic Penumbra, or GIP. Like every other organ, the brain shuts down its function when its blood flow is reduced in order to conserve energy. At 70 percent of normal blood flow, the brain’s neurological functioning is reduced, and at a 50 percent reduction the EEG becomes flatline. But tissue damage doesn’t begin until blood flow to the brain drops below 20 percent of normal for several hours. GIP is a term doctors use to refer to that interval when the brain’s blood flow is between 20 and 50 percent of normal. During GIP the brain will not respond to neurological testing and has no electrical activity on EEG, but still has enough blood flow to maintain tissue viability — meaning that recovery is still possible. During GIP, a person will appear “brain dead” using the current medical guidelines and testing, but with continuing care they could potentially improve.

Dr. D. Alan Shewmon, one of the world’s leading authorities on brain death, describes GIP this way:

This [GIP] is not a hypothesis but a mathematical necessity. The clinically relevant question is therefore not whether GIP occurs but how long it might last. If, in some patients, it could last more than a few hours, then it would be a supreme mimicker of brain death by bedside clinical examination, yet the non-function (or at least some of it) would be in principle reversible.

Dr. Cicero Coimbra first described GIP in 1999, but in the never-ending quest for transplantable organs, his work has been largely ignored. There is absolutely no medical or moral certainty in a brain death diagnosis, and people need to be made aware of this. “Brain dead” people are very ill, and their prognosis may be death, but they deserve to be treated aggressively until they either recover or succumb to natural death. Unfortunately, as the family of Terrance Howard seems to have experienced, doctors are continuing to use a brain death guideline that ignores the reality of GIP and does not comply with brain death law under the UDDA.

Heidi Klessig MD is a retired anesthesiologist and pain management specialist who writes and speaks on the ethics of organ harvesting and transplantation. She is the author of “The Brain Death Fallacy” and her work may be found at respectforhumanlife.com.