Brain death determination: the imperative for policy and legal initiatives in Sub-Saharan Africa.
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The concept of brain death (BD), defined as irreversible loss of function of the brain including the brainstem, is accepted in the medical literature and in legislative policy worldwide. However, in most of Sub-Saharan Africa (SSA) there are no legal guidelines regarding BD. Hypothetical scenarios based on our collective experience are presented which underscore the consequences of the absence of BD policies in resource-limited countries (RLCs). Barriers to the development of BD laws exist in an RLC such as Kenya. Cultural, ethnic, and religious diversity creates a complex perspective about death challenging the development of uniform guidelines for BD. The history of the medical legal process in the USA provides a potential way forward. Uniform guidelines for legislation at the state level included special consideration for ethnic or religious preferences in specific states. In SSA, medical and social consensus on the definition of BD is a prerequisite for the development BD legislation. Legislative policy will (1) limit prolonged and futile interventions; (2) mitigate the suffering of families; (3) standardise clinical practice; and (4) facilitate better allocation of scarce critical care resources in RLCs. There is a clear-cut need for these policies, and previous successful policies can serve to guide these efforts.
Published Version (Please cite this version)10.1080/17441692.2015.1094108
Publication InfoClement, Meredith; Kussin, PS; Lukoko, L; Naanyu, V; Nadel, S; Rosoff, Philip Martin; & Waweru-Siika, W (2015). Brain death determination: the imperative for policy and legal initiatives in Sub-Saharan Africa. Glob Public Health. pp. 1-12. 10.1080/17441692.2015.1094108. Retrieved from https://hdl.handle.net/10161/13351.
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Professor Emeritus of Pediatrics
My main interests are clinical ethics with a concentration on the equitable allocation of scarce resources (rationing). In this area, I have done work on planning for pandemic influenza and allocation of drugs during shortages. I play a major role in the Clinical Ethics Service at Duke Hospital and chair the hospital's Ethics Committee.
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