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Criteria for Determining Brain Death Differ by Hospital

Improvement seen with AAN practice parameters, but significant variability still exists

MONDAY, Dec. 28, 2015 (HealthDay News) — There is still considerable variation in hospital policies for the determination of brain death, according to a study published online Dec. 28 in JAMA Neurology.

David M. Greer, M.D., from the Yale University School of Medicine in New Haven, Conn., and colleagues examined whether institutions have adopted the new American Academy of Neurology (AAN) guidelines on the determination of brain death. Fifty-two organ procurement organizations provided U.S. hospital policies relating to the criteria for determining brain death. Data were analyzed from June 26, 2012, to July 1, 2015.

The researchers obtained 508 unique hospital policies, of which 492 provided adequate data for analysis. There was readily apparent improvement with AAN practice parameters, although significant variability remained across all five categories of data, such as excluding the absence of hypotension (56.2 percent of policies) and hypothermia (79.4 percent of policies), specifying all aspects of the clinical examination and apnea testing, and specifying appropriate ancillary tests and their performance. Overall, 33.1 percent of the policies required health care professionals to have specific expertise in neurology or neurosurgery for determining brain death, while 43.1 percent specified that an attending physician could determine brain death. One hundred fifty policies did not specify who could determine brain death.

“Hospitals should be encouraged to implement the 2010 AAN guidelines to ensure 100 percent accurate and appropriate determination of brain death,” the authors write.

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