Study finds significant differences in protocols hospitals use to determine b...( A survey of some of the top hospital...),Health

A survey of some of the top hospitals in the country has found that protocols followed to determine brain death differ significantly among those institutions. In the January 22 issue of the journal Neurology, a team of researchers reports finding that brain death protocols at hospitals cited as top neurology and neurosurgery centers by U.S. News and World Report often do not follow the standards established by the American Academy of Neurology (AAN). The paper has received early online release.

We were surprised to find such significant differences among these hospitals in terms of their specified guidelines for brain death determination, says David Greer, MD, of the Massachusetts General Hospital (MGH) Neurology Service, who led the study. In reviewing the protocols, we would have anticipated more consistency with the American Academy of Neurology practice parameters.

The concept of brain death irreversible loss of function in the entire brain was first established in the 1960s, and in 1981 a Presidential Commission confirmed that brain death was the legal equivalent of more traditional standards, such as the cessation of heart and lung function. The Uniform Determination of Death Act, which has been enacted by most U.S. states, specifies that guidelines for determining death be made in accordance with accepted medical standards, and in 1995 the AAN published practice guidelines based on an evidence-based review of the literature and best practices.

Greer and his collaborators from Mayo Clinic and Henry Ford Hospital designed their study because of their own perceptions that major discrepancies could exist among guidelines at different hospitals. They contacted representatives of the top 50 neurology and neurosurgery programs, listed in the U.S. News 2006 Best Hospitals issue, requesting copies of their institutional guidelines for determining brain death. Of the 41 programs that responded, 3 did not have written guidelines, l
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