Brain Death Policies In Hospitals Vary Despite National Standards
A recently published Yale University-led study offers a provocative insight as to how hospitals determine brain-dead patients across the United States. A research published in JAMA Neurology reveals glaring lapses and practices that are hugely inconsistent with national guidelines specifically designed to narrow down failures and curb dramatic errors in determining brain death by hospitals.
"This is truly one of those matters of life and death, and we want to make sure this is done right every single time. The worst-case scenario would be if we were to pronounce somebody brain-dead and then they recovered some neurological function," remarked neurologist and main research proponent David Greer of Yale University School of Medicine as quoted saying by NPR.
To achieve 100% certainty in brain death cases, the American Academy of Neurology (AAN) adopted a standardized set of guidelines in determining whether a patient is truly brain dead and being supported only by machines.
"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. You should be able to take this checklist to the bedside, follow it point by point and be able to get through it," said Greer as mentioned by WebMD.
The study involved a careful review of 508 hospital policies across all 50 American states. The researchers found a number of errors and practices by hospitals that are essentially unacceptable by AAN standards.
In many cases, some hospitals did not require the presence of fully trained medical expert such as a neurologist or a neurosurgeon to make the appropriate judgment. The study also exposed that 20% of hospitals did not even require doctors to make a basic brain death assessment such as checking the temperature according to Medical Daily.
Some neurologists also find the study surprising and upsetting at the same time. For example, 10% of the hospitals reviewed did not require apnea test- ensuring a patient can no longer breathe on his or her own.
"That is an absolute requirement. No one should ever do a brain death determination without an apnea test. Determining apnea is essential," told Dartmouth's Geisel School of Medicine neurologist Dr. James Bernat as quoted in an article by KTBS News.
While it is true that variations of hospital policies are also influenced by state-based legal requirements, there are core procedures that should be followed in order for hospitals to act within the evidence-based confines of medical knowledge and standard the researchers said.