Brain Death Guidelines, Policies Depend on Hospitals: Study

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In 2010, the American Academy of Neurology had set evidence-based guidelines on determining brain deaths in adults. However, a new study reports that the rules for judging when a patient is brain dead are very inconsistent, depending on the hospital, despite AAN's national standards to ensure accuracy, HealthDay reports. The crucial part of the process is determining whether a patient is brain dead, and this responsibility lies in hospital doctors and staff.

While there are no legitimate reports saying a patient was declared brain dead when they were in fact, not, lead researcher Dr. David Greer, a professor of neurology at the Yale School of Medicine, in New Haven, Connecticut believes that the judgments and ultimately, the decision should be made with "100% certainty." Greer was also part of the team who wrote the set of guidelines for determining brain death in 2010, which is now being recommended by the AAN to every hospital in the U.S.

"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," Dr. 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."

Researchers analyzed 508 hospital policies concerning brain death standards, with health systems ranging from all 50 states. Results showed that only 56% of the hospital policies required doctors to rule out hypotension or severely low blood pressure, as a factor that may create the illusion of brain death. Researchers also found that one out of every five policies did not require doctors to rule out hypothermia, which is abnormally low body temperature, as a possible factor for brain death.

According to Medical Daily, researchers also found that a number of hospitals did not require a neurologist, neurosurgeon, or a fully trained doctor to decide to remove life support. Greer said that some hospitals allowed a nurse practitioner or physician assistant to do it.

"This is truly one of those matters of life and death, and we want to make sure this is done right every single time," Dr. Greer told NPR. "The worst-case scenario would be if we were to pronounce somebody brain-dead and then they recovered some neurological function. That would be horrific if that were the case."

This new study brings to light the concerning discrepancy between hospital policies across the nation. According to Dartmouth College neurologist James Bernat, "It's disturbing that despite all of the educational intervention to try to bring doctors up to the national standards that there remains such great variability."