## Facts

- Aden Hailu, a 20-year-old university student, underwent surgery at St. Mary’s Regional Medical Center and suffered catastrophic anoxic brain injury; she never regained consciousness.
- Early neurological testing (including multiple EEGs) showed some brain activity; a hospital neurologist initially concluded she was not brain dead but was declining.
- The hospital later performed an apnea test and determined that Hailu met brain-death criteria under American Association of Neurology (AAN) guidelines; it notified her father and guardian, Fanuel Gebreyes, that it intended to withdraw ventilator and other life support.
- Gebreyes sought emergency injunctive relief to prevent withdrawal of life-sustaining treatment and to permit transfer and further care (including placement of a feeding tube).
- At an evidentiary hearing, the hospital’s physicians testified the AAN guidelines were the accepted medical standard for determining brain death in Nevada and that Hailu satisfied those criteria.
- Gebreyes’s expert agreed that Hailu appeared to meet AAN brain-death criteria and had a grim prognosis, but opined the chance of recovery was not zero and pointed to factors (e.g., age and bodily functioning) suggesting possible improvement.
- The district court denied a temporary restraining order and permanent injunction, concluding the hospital’s AAN-based determination satisfied Nevada’s statutory definition of death.
- Gebreyes appealed.

## Issues

1. Whether, under NRS 451.007, the AAN brain-death guidelines constitute “accepted medical standards” that establish “irreversible cessation of all functions of the person’s entire brain, including his or her brain stem.”
2. Whether the district court erred by treating use of the AAN guidelines, without sufficient analysis, as compliance with NRS 451.007.

## Decision

- The Nevada Supreme Court reversed the order denying injunctive relief and remanded.
- The Court held the district court did not adequately analyze whether the AAN guidelines, as applied, measure the statutory requirement of irreversible cessation of all functions of the entire brain, including the brain stem.
- The Court required further proceedings to determine whether the AAN guidelines satisfy NRS 451.007 and qualify as “accepted medical standards” in the statutory sense, including considering how “accepted medical standards” is understood in jurisdictions adopting the Uniform Determination of Death Act (UDDA).
- The Court did not decide that the AAN guidelines are categorically insufficient and did not declare Hailu legally alive; it held only that the record and analysis were inadequate to support the district court’s conclusion.

## Legal Principles

- Under NRS 451.007, legal death by neurologic criteria requires an irreversible cessation of all functions of the person’s entire brain, including the brain stem.
- NRS 451.007 also requires that the death determination be made in accordance with accepted medical standards.
- A court may not presume that widely used professional guidelines automatically satisfy a statute’s specific “entire brain” and “all functions” requirements; it must evaluate whether the method actually measures what the statute demands.
- When a statute tracks the UDDA, “accepted medical standards” analysis may require consideration beyond local practice, including whether the standard is accepted as satisfying the UDDA’s full statutory test.

## Conclusion

The Nevada Supreme Court reversed and remanded because the district court failed to conduct a sufficient statutory and evidentiary analysis showing that the AAN brain-death guidelines both (1) measure irreversible cessation of all functions of the entire brain, including the brain stem, and (2) qualify as “accepted medical standards” under NRS 451.007.


In re Guardianship of Hailu, 361 P.3d 524 (Nev. 2015)