Pregnancy and Brain Death: Lack of Guidance in U.S. Hospital Policies

Abstract

Objective The death of Marlise Muñoz, a pregnant woman who suffered an anoxic brain injury in November 2013, highlights the social, ethical, legal, and medical controversies associated with brain death in pregnancy. We sought to evaluate whether institutions in the United States have policies in place for situations in which a pregnant woman is declared brain dead.

Study Design Institutional brain-death protocols from hospitals in the United States were obtained in cooperation with local and regional organ procurement agencies. Each protocol was reviewed to determine if and how it addressed brain death in pregnancy.

Results We reviewed 317 unique brain-death protocols. In eight protocols (2.5%), it was noted that a pregnant patient could not be evaluated for brain death if the fetus could be preserved. Of the protocols that permitted brain-death evaluation, 289 (93.8%) did not include guidance about fetal management after maternal brain death and 305 (99%) did not indicate who was responsible for making decisions for the fetus.

Conclusion Very few institutional brain-death policies address the issue of pregnancy. The creation of guidelines on management of the social and ethical challenges associated with brain death in pregnancy may be helpful.

Keywords

brain death - ethics - fetus - guidelines - medical and legal - pregnancy

Note

Ariane Lewis has no financial disclosure or conflict of interest. Panayiotis Varelas is a member of the advisory board of Gift of Life in Michigan. David Greer is the editor-in-chief of journal Seminars in Neurology. This article represents valid work and neither this article nor one with substantially similar content has been published or is being considered for publication elsewhere.

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