Even though there are national standards to ensure accuracy when pronouncing a patient brain dead, a new study has found that hospitals are extremely inconsistent when determining what qualifies a patient as “brain dead.”
The American Academy of Neurology implemented 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.
“This is truly one of those matters of life and death, and we want to make sure this is done right every single time,” says Greer, who helped to write the detailed set of guidelines.
Differences in policy on 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.
“The worst-case scenario would be if we were to pronounce somebody brain-dead, and then they recovered some neurological function,” Greer says. “That would be horrific if that were the case.”
Although Greer did point out that there are no legitimate reports of any patient ever being declared brain dead when they weren’t.
“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 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 study compared the policies of 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, according to UPI.
The study did note that there were many hospitals that had made some progress since new guidelines were accepted by the American Academy of Neurology in 2010. However, only one-third of hospitals in the study required expertise in neurology or neurosurgery to determine brain death, with only 43 percent requiring the decider to be an attending physician.
Greer said, for a person to be ruled brain dead two judgments must be made:
“First, they have to prove that there is no brain function at all. “Even the most basic things such as taking a breath constitutes brain function,
“Second, there must be no chance that the person may recover any brain function. For example, doctors have to make sure that the person isn’t suffering from a condition that resembles brain death.”
“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.
Researchers found that both of these rules vary widely between hospitals, and often did not stick to the guidelines.
There were only 56.2 percent of hospitals that checked blood pressure, while only 79.4 percent checked temperature. Both could indicate low brain activity, and would lead doctors to run additional testing before declaring brain death. One in ten hospitals did not require an apnea test, which indicates whether a patient can breathe on their own.
“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.”
The study was published in JAMA Neurology.