What is the Uniform Determination of Death Act (UDDA)?

The Uniform Law Commission drafted the Uniform Determination of Death Act (UDDA) in 1980. The UDDA provides a legal definition of death.

Before the UDDA, common law and accepted medical practices defined death differently. Under common law and accepted medical practice, death was when all vital functions stopped. Primary death indicators were a lack of spontaneous respiratory and cardiac action.

But advancements in medical technology helped keep people alive who wouldn't have survived before. These technologies include ventilators and feeding tubes. The line between life and death blurs when body functions continue without brain activity.

The Uniform Determination of Death Act is a model legislation adopted nationwide. It provides a more concrete definition of death for legal purposes.

This article covers the basics of the UDDA, its legal significance, exceptions, and controversies.

What Is Brain Death?

For centuries, the accepted medical standard for determining death was the end of the body's functions, primarily the heart. Cardiopulmonary resuscitation can restart the heart and bring people back to life. Otherwise, that person was dead.

But medicine advanced. Fields like organ transplantation grew. So did the need to keep people "alive" long enough to donate organs.

Harvard's Definition

This was the impetus behind Harvard University's 1968 "A Definition of Irreversible Coma." This report came almost one year after the world's first successful heart transplant. This transplant raised bioethical questions about death for clinicians. Were heart donors dead when transplant surgeons removed their hearts? Or did removing their heart kill them? Harvard's medical school put together a committee to consider this ethical issue.

Harvard's ad hoc committee concluded that the loss of neurological function, or brain death, defined death. Brain death differs from a persistent vegetative state. Brain death is synonymous with brainstem death. In both instances, there is an irreversible end of all functions of the entire brain.

The American Academy of Neurology

According to the American Academy of Neurology (AAN), brain death includes:

• A coma
• No brainstem reflexes
• Apnea (when breathing stops)

The AAN has adopted the UDDA definition of brain death. However, the question of hypothalamic-pituitary function and brain death remains unresolved. (The hypothalamus maintains the internal balance of our bodies.)

Dead-Donor Rule

This new concept of death led to the dead-donor rule. The dead-donor rule allows organ donation from brain-dead persons with a heartbeat. Today a neurologist must determine death by neurologic criteria before organ donation. This means a person on life support or in critical care with a heartbeat meets the neurologic criteria for death.

Uniform Determination of Death Act Overview

The Uniform Law Commission (ULC) drafted the UDDA. The ULC is a volunteer organization. It provides uniformity and clarity to different areas of the law. The ULC was the National Conference of Commissioners on Uniform State Laws. The Uniform Law Commission's work led to the enactment of many standard state laws.

Kansas passed the first death determination statute in 1970. In 1975, the American Bar Association (ABA) drafted the Model Definition of Death Act. In 1979, the American Medical Association (AMA) created the Model Definition of Death Statute. Over 25 state legislatures used one of these two models. There was an apparent legal disparity when determining when someone was dead.

The disparity between the common law determination of death and accepted medical practice pointed to the need for a uniform law.

One goal of the Uniform Determination of Death Act was to close this disparity. The ULC joined forces with the ABA, the AMA, and a Presidential Commission to provide a consistent basis for determining death. The President's Commission was the Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. The ABA and the AMA approved the UDDA shortly after publication.

Health care is generally a matter of state law. The Act intended to provide a standard for states to emulate.

Uniform Determination of Death Act Definitions

The Uniform Determination of Death Act offers two statutory definitions for when an individual is legally declared dead:

1. Circulatory and respiratory functions irreversibly stop; or
2. All functions of the entire brain, including the brain stem, irreversibly stop.

Under the legal standard for death (or the "brain death standard"), all brain functions, including the brain stem, stop. This is the irreversible cessation of all functions of the entire brain.

The most common type of death is the first definition—when the heart stops beating or the patient is no longer breathing. Brain death usually follows. Today individuals stay "alive" with ventilators and feeding tubes despite no brain activity. Most states consider brain-dead individuals legally dead and remove them from life support. Through life support, the body functions until organ donation.

Legal Significance of the Uniform Determination of Death Act

The Act primarily aims to align the legal definition of death with the accepted medical standards. Modern technology allows for direct monitoring of brain activity. We can maintain breathing and circulation in the absence of brain activity. The traditional definition of death needed expansion.

The UDDA is strictly limited to the legal determination of death. It does not address medical ethics.

Legal Examples

The definition of death outlined in the Uniform Determination of Death Act is relevant in many legal situations. A few examples include the following:

• Time of Death: Under the UDDA, time of death is a legal fact and one of many to determine on a case-by-case basis. If there is any controversy over the time of death, the UDDA recommends resolution through expert testimony.

• Organ Donation: Organ procurement requires the maintenance of organs and tissues. The determination of brain death is final and can help streamline the process. It does so by eliminating ambiguity. A legal conclusion of death helps family members in the decision-making process. It is easy to assume your loved one is still alive if they are on life support. By determining brain death, we understand this person will not return to life.

• Criminal Cases: Prosecutors need to legally determine death before bringing homicide charges. For example, suppose the victim of a crime is in a coma following an assault. In that case, the prosecutor charges the alleged perpetrator with lesser crimes, such as aggravated assault. The prosecutor will revise the charges if physicians take the victim off life support and declare them dead.

• Tort Actions: The determination of death is necessary for a wrongful death lawsuit or other survivors' legal actions.

• Estate Law: Benefactors can't inherit without a determination of death.

• Life Insurance: Brain-dead individuals cannot provide for their families. A death determination allows for the disbursement of life insurance funds.

Determination of Brain Death: Exceptions

Thirty-seven states (and the District of Columbia) have adopted the Uniform Determination of Death Act. New Jersey has not.

New Jersey includes cardio-respiratory criteria in its respective determination of death laws. The patient's heart and lungs cannot function without support. These laws also have religious exemptions. They prohibit a declaration of death when it conflicts with the patient's religious beliefs. This means that a physician will only use cardio-respiratory criteria in determining death.

The New Jersey Declaration of Death Act (NJDDA) requires whole-brain death and loss of cardio-respiratory function. New Jersey does not solely rely on a declaration of brain death.

In most states, only a physician can determine death. Michigan is one exception. In Michigan, a registered nurse makes this determination.

Controversies

Dr. Alan Shewmon, MD, a retired professor of pediatrics and neurology, has advanced opposition against the Uniform Determination of Death Act. This is because patients cannot agree to tests to determine brain death. Shewmon believes this lack of authorization constitutes an unethical violation of bodily integrity. Shewmon also takes issue with the efforts of neurologists such as Dr. Ariane Lewis to revise the UDDA.

More Questions About the UDDA? A Health Care Attorney Can Help

The Uniform Determination of Death Act is complex. It can impact organ donor decisions. For technical information on the Act, you can search PubMed. For legal expertise on the UDDA, speak with an experienced local healthcare attorney.