NEW HAVEN, Conn., Dec. 28 (UPI) — Although national standards exist, rules to establish brain death vary widely from hospital to hospital, according to a new study.
Properly pronouncing a patient brain dead matters, researchers said in the study, so they were surprised practices are not more uniform between facilities.
Differences in policy about who judges whether a patient is brain dead or whether to check temperature and blood pressure before declaring brain death are concerning, researchers said because of the need for clarity on a literal life-and-death measure.
For patients who are organ donors, the researchers said properly deciding if a patient is brain dead, or whose brain function may just be suppressed, has large ramifications.
“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. David Greer, a professor of neurology at the Yale School of Medicine, told HealthDay. “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.”
The researchers compared policies at 508 hospitals, obtained by 52 organ procurement organizations, for five categories of data: who is qualified to determine brain death, prerequisites for testing for brain death, details of clinical exam, details of apnea testing, and the details of ancillary tests.
While researchers note in the study, published in JAMA Neurology, that many hospitals have made progress since new guidelines were adopted by the American Academy of Neurology in 2010, barely one-third of hospitals in the study required expertise in neurology or neurosurgery to determine brain death, and only 43 percent required the decider be an attending physician.
Only 56.2 percent of hospitals checked blood pressure and 79.4 percent checked temperature, both of which can indicate low brain activity, and lead doctors to run additional testing before declaring brain death. One in ten hospitals did not require an apnea test, which tells whether a patient can breathe on their own.
Declaring a person brain dead is based on proving they have no brain function and there is no chance of recovery, Greer said, making the decision difficult and requiring of a lot of caution.
“There are very few things in medicine that should be black and white, but this is certainly one of them,” Greer told NPR. “There really are no excuses at this point for hospitals not to be able to do this 100 percent of the time.”
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