Hospitals vary widely in determining brain death

NEW YORK (Reuters Health) - Guidelines for determining brain death differ substantially between major U.S. hospitals, a national survey shows, and few stick to parameters established by the American Academy of Neurology.

"There are substantial differences in practice that may have consequences for the determination of death and initiation of transplant procedures," Dr. David M. Greer, at Massachusetts General Hospital in Boston, and colleagues report in the medical journal Neurology.

Greer's team requested guidelines from hospitals named as having the top 50 neurology programs in the nation in 2006 by US News and World Report.

Only 42 percent of the hospitals required that a neurologist or neurosurgeon perform the examination for brain death, results showed. Among the 71 percent that stipulated multiple examinations, the time required between examinations varied from 1 to 24 hours.

Furthermore, the authors point out, "It was surprising to find that the cause of brain death was not stipulated in a large number (37 percent) of guidelines."

They observed overall good compliance (82 percent to 100 percent) with most of the tests required for the clinical examination, although fewer than half of the hospitals mandated testing for pain in the cranium, jaw jerk, and absence of spontaneous respirations.

Commenting on this "disturbing pattern of non-uniformity," Dr. James L. Berna from Dartmouth Medical School in Hannover, New Hampshire, writes in an editorial that current guidelines also need to be updated.

SOURCE: Neurology, January 22, 2008.