Policies on brain death vary significantly by hospital

A new study in JAMA Neurology finds that policies to determine brain death vary significantly among hospitals in the United States and most don't fully follow national guidelines.

The American Academy of Neurology (AAN) issued new guidelines in 2010 that every hospital should follow when declaring patients brain-dead. The guidelines are extensive and include a detailed checklist as well as step-by-step instructions.

But researchers who examined 492 unique hospital policies found that the policies are inconsistent and many organizations have not fully implemented the guidelines.

For example, more than 20 percent of hospitals don't require clinicians to check a patient's temperature; 56 percent don't assess a patient's blood pressure; and only 33 percent require an expert in neurology or neurosurgery to determine brain death. In addition, 150 policies fail to mention who could determine brain death.

The danger is that without a standard policy, hospital staff--especially a less experienced clinician--could mistakenly mispronounce someone brain dead.

"This is truly one of those matters of life and death, and we want to make sure this is done right every single time," lead author David Greer, M.D., a neurologist at the Yale University School of Medicine, told NPR.

Greer helped write the 2010 guidelines and told the publication that the potential danger is that a hospital could declare someone brain dead who later recovers some neurological function. "That would be horrific if that were the case," he said.

In an interview with U.S. News & World Report, Greer said it may be time for the Joint Commission to make it part of the hospital accreditation process to ensure that hospitals uniformly update their policies and follow the AAN guidelines.

To learn more:
- here's the study abstract
- read the NPR report
- check out the U.S. News & World Report story

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