This is a tough one.


Readers will remember the case of Jahi McMath, the unfortunate 13 year old who underwent an operation to treat sleep apnea, including tonsillectomy. Post-op Jahi was coughing up blood. The following morning her heart rate dropped and she went into cardiac arrest. Three days later she was declared brain dead. The family challenged the hospital’s decision to take the patient off the ventilator. The family won the right to transfer Jahi to an undisclosed location in New Jersey.


The family just filed a medical malpractice lawsuit naming the ENT surgeon and UCSF Benioff Children’s Hospital as defendants. That lawsuit comes as no surprise.


What does come as a surprise is:


Since Jahi was moved, three doctors have signed a declaration stating Jahi McMath is not brain dead, according to bioethicist Wesley Smith.

They include Charles J. Prestigiacomo, director of Cerebrovascular and Endovascular Neurosurgery at University Hospital in Newark and chair of the neurological surgery department at Rutgers and two internationally respected neurologists Dr. Alan Shewmon and Dr. Calixto Machado.

Another post noted:


The brain structure evidenced in the MRI is not consistent with an MRI of a patient that has been brain dead over nine months,” Prestigiacomo wrote in his declaration after reviewing tests on McMath conducted at University Hospital. He added that McMath has a “very significant brain injury but she doesn’t meet the criteria for brain dead.


The family attorney will petition the California Secretary of State to rescind the death certificate. The attorney stated if this petition is denied, he will sue.


Brain death criteria were designed to be conservative. Brain death is defined as the irreversible loss of all functions of the brain, including the brainstem. The three essential findings in brain death are coma, absence of brainstem reflexes, and apnoea. An evaluation for brain death should be considered in patients who have suffered a massive, irreversible brain injury of identifiable cause. A patient determined to be brain dead is legally and clinically dead.


The diagnosis of brain death is primarily clinical. No other tests are required if the full clinical examination, including each of two assessments of brain stem reflexes and a single apnoea test, are conclusively performed.


Brain death can typically be certified by a single physician privileged to make brain death determinations.


Once a person is declared brain dead, can that determination be reversed? What about after 9 months? It would be helpful to better understand what the patient’s clinical exam revealed.