Hospitals' Brain Death Policies Vary Dramatically
Researchers fear organ donations might drop if potential donors don't think proper steps are taken every time
By Dennis Thompson
MONDAY, Dec. 28, 2015 (HealthDay News) -- The rules for judging when a patient is brain dead vary widely from hospital to hospital, despite the existence of national standards created to ensure accuracy, a new study has found.
The American Academy of Neurology adopted a set of updated guidelines in 2010 for judging whether a person has lost all brain function and is being kept alive solely through hospital machinery, said lead researcher Dr. David Greer, a professor of neurology at the Yale School of Medicine, in New Haven, Conn.
There are no legitimate reports of any patient ever being declared brain dead when they weren't, Greer said, but such judgments need to be made with "100 percent certainty."
"That's why we want to provide a very high level of accountability for this, and that's why we created the guidelines to be so specific, so straightforward and cookbook," Greer said. "Basically, you might call it 'Brain Death For Dummies.' You should be able to take this checklist to the bedside, follow it point by point and be able to get through it."
But hospitals have been slow to adopt the brain death standards in their policies, Greer and colleagues found in a national review.
They reviewed 508 hospital policies regarding brain death, representing hospitals and health systems in all 50 states. The results were published online Dec. 28 in the journal JAMA Neurology.
To rule a person brain dead, physicians must make two judgments, Greer said.
They have to prove there's no brain function at all, even to regulate automatic processes in the body. "Even the most basic things such as taking a breath constitutes brain function," he said.
They must also rule out any chance that the person might recover brain function. For example, doctors have to make sure the person isn't suffering from a condition that resembles brain death, Greer said.
"If there's any chance that, by continuing to treat the patient or by eliminating some unknown factor, the patient might retain some brain function, then you don't declare them," he said.