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January 22, 2008; 70 (4) Articles

Variability of brain death determination guidelines in leading US neurologic institutions

David M. Greer, Panayiotis N. Varelas, Shamael Haque, Eelco F.M. Wijdicks
First published December 12, 2007, DOI: https://doi.org/10.1212/01.wnl.0000296278.59487.c2
David M. Greer
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Panayiotis N. Varelas
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Shamael Haque
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Eelco F.M. Wijdicks
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Citation
Variability of brain death determination guidelines in leading US neurologic institutions
David M. Greer, Panayiotis N. Varelas, Shamael Haque, Eelco F.M. Wijdicks
Neurology Jan 2008, 70 (4) 284-289; DOI: 10.1212/01.wnl.0000296278.59487.c2

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Abstract

Background: In accordance with the Uniform Determination of Death Act, guidelines for brain death determination are developed at an institutional level, potentially leading to variability of practice. We evaluated the differences in brain death guidelines in major US hospitals with a strong presence of neurology and neurosurgery to determine whether there was evidence of variation from the guidelines as put forth by the American Academy of Neurology (AAN).

Methods: We requested the guidelines for determination of death by brain criteria from the US News and World Report top 50 neurology/neurosurgery institutions in 2006. We evaluated the guidelines for five categories of data: guideline performance, preclinical testing, clinical examination, apnea testing, and ancillary tests. We compared the guidelines directly with the AAN guidelines for consistencies/differences.

Results: There was an 82% response rate to requests. Major discrepancies were present among institutions for all five categories. Variability existed in the guidelines' requirements for performance of the evaluation, prerequisites prior to testing, specifics of the brainstem examination and apnea testing, and what types of ancillary tests could be performed, including what pitfalls or limitations might exist.

Conclusions: Major differences exist in brain death guidelines among the leading neurologic hospitals in the Unites States. Adherence to the American Academy of Neurology guidelines is variable. If the guidelines reflect actual practice at each institution, there are substantial differences in practice which may have consequences for the determination of death and initiation of transplant procedures.

Glossary

AAN=
American Academy of Neurology;
ABG=
arterial blood gas;
ICU=
intensive care unit;
SBP=
systolic blood pressure.
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Disputes & Debates: Rapid online correspondence

  • Variability of brain death determination guidelines in leading US neurologic institutions
    • Tia Powell, New York State Task Force on Life & the Law, 90 Church Street, 15th Floor, New York, NY 10007tpp03@health.state.ny.us
    • James Zisfein, John Halperin
    Submitted March 12, 2008
  • Reply from the authors
    • David M. Greer, Massachusetts General Hospital, ACC 739A, 55 Fruit Street, Boston, MA, 02114dgreer@partners.org
    • Panayiotis N. Varelas, Shamael Haque, Eelco F.M. Wijdicks
    Submitted March 12, 2008
  • Variability of brain death determination guidelines in leading US neurologic institutions
    • Calixto Machado, AAN Corresponding Fellow, Institute of Neurology and Neurosurgery, 29 y D, Vedado, La Habana 10400, Cubabraind@infomed.sld.cu
    Submitted February 14, 2008
  • Variability of brain death determination guidelines in leading US neurologic institutions
    • Kao-Chang Lin, Neurology, Chi Mei Medical Center, 901, Jong Hwa Rd, Yung Kung City, Tainan Hsien, Taiwangaujang@mail2000.com.tw
    • Jinn-Rung Kuo, Neurosurgery, Chi Mei Medical Center
    Submitted February 14, 2008
  • Reply from the authors
    • David M. Greer, MD, MA, Massachusetts General Hospital, ACC 739A, 55 Fruit Street, Boston, MA 02114dgreer@partners.org
    • Panayiotis Varelas MD, PhD, Shamael Haque DO, Eelco F.M. Wijdicks MD, PhD
    Submitted February 14, 2008
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