Neurological Prognostication, Brain Death and Neuroethics

Our group has a unique expertise in brain death diagnosis and management. We have made provocative clinical observations in brain death that have been formally presented and published, and we have been instrumental in facilitating the evolution, understanding and approach to brain death. In the past, we have become interested in the process of solid organ donation after cardiac death (DCD), and we have systematically studied both pitfalls in the process as well as the neurological spectrum of patients considered ideal candidates for DCD.

We have been disturbed about the absence of uniformity in hospital policies and physician practice with respect to brain death diagnosis and management. This is related to poor physician education and leadership. In an effort to enhance "ownership" and leadership for brain death we developed The University of Chicago International Brain Death Simulation Workshop. This highly successful annual workshop is now considered a benchmark for education leaders and change agents in the field. We have also been instumental in developing a webinar on the topic with colleagues froms several other academic centers and directing a related course at the annual meeting of our specialty society.

We have recently completed three major clinical research projects on brain death addressing specific clinical features of brain death diagnosis (the midposition pupil size and symmetry), physiology of brain death (diabetes insipidus and hypothermia), and high variability in brain death diagnositic/documetation practice within a large geographic region. Each of these projects are proving to be instrumental in changing the landscape of the acceptance of the coherence of the whole brain formulation of death, the necessity of better physician practice and policy uniformity, and establishing the tools to achieve better uniformity in understanding and practice.