Brain Death Determination Still Differs Despite Guidelines

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Brain Death Determination Still Differs Despite Guidelines
Brain Death Determination Still Differs Despite Guidelines

HealthDay News — There is still considerable variation in hospital policies for the determination of brain death, according to a study published in JAMA Neurology.

David M. Greer, MD, from the Yale University School of Medicine in New Haven, Conn., and colleagues examined whether institutions have adopted the new American Academy of Neurology (AAN) guidelines on the determination of brain death. Fifty-two organ procurement organizations provided U.S. hospital policies relating to the criteria for determining brain death. Data were analyzed from June 26, 2012, to July 1, 2015.

The researchers obtained 508 unique hospital policies, of which 492 provided adequate data for analysis. There was readily apparent improvement with AAN practice parameters, although significant variability remained across all 5 categories of data, such as excluding the absence of hypotension (56.2% of policies) and hypothermia (79.4% of policies), specifying all aspects of the clinical examination and apnea testing, and specifying appropriate ancillary tests and their performance. Overall, 33.1% of the policies required health care professionals to have specific expertise in neurology or neurosurgery for determining brain death, while 43.1% specified that an attending physician could determine brain death. One hundred fifty policies did not specify who could determine brain death.

"Hospitals should be encouraged to implement the 2010 AAN guidelines to ensure 100% accurate and appropriate determination of brain death," the authors write.

Reference

Greer DM, Wang HH, Robinson JD, Varelas PN, Henderson GV, Wijdicks EM. Variability of Brain Death Policies in the United States. JAMA Neurol. 2015; doi:10.1001/jamaneurol.2015.3943.

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