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Published on: December 18, 2016
Improving uniformity in brain death determination policies over time
Hilary H Wang1, Panayiotis N Varelas1, Galen V Henderson1
1From the Department of Neurology (H.H.W., D.M.G.), Yale University School of Medicine, New Haven, CT; Department of Neurology (P.N.V.), Henry Ford Hospital, Detroit, MI; Department of Neurology (G.V.H.), Harvard Medical School, Cambridge, MA; and Department of Neurology (E.F.M.W.), Mayo Clinic, Rochester, MN.
Brain death determination guidelines have improved in top U.S. neurology institutions, particularly in apnea and ancillary testing criteria. However, variability persists, indicating that voluntary updates alone are insufficient for full guideline unification.
Area of Science:
- Neurology
- Medical Ethics
- Healthcare Policy
Background:
- Brain death determination guidelines are crucial for organ donation and patient care.
- Variability in these guidelines can lead to inconsistencies in clinical practice.
- Previous studies have highlighted the need for greater uniformity in brain death protocols.
Purpose of the Study:
- To assess progress in unifying brain death determination guidelines.
- To compare policies of top U.S. neurology institutions from 2006 and 2015.
- To evaluate compliance with the American Academy of Neurology Practice Parameters (AANPP).
Main Methods:
- Solicited official hospital guidelines from 50 top-ranked neurologic institutions in 2015.
- Compared 2015 guidelines with a 2006 cohort and AANPP criteria.
- Analyzed compliance in five key categories, including apnea and ancillary testing.
Main Results:
- Significant improvement in guideline compliance from 2008 to 2015 (p = 0.005).
- Particular progress noted in apnea testing (p = 0.009) and ancillary testing (p = 0.0006).
- Continued variability exists in areas like ancillary test specifics and physician involvement.
Conclusions:
- The 2010 AANPP update aligns with progress in guideline uniformity.
- Solely relying on voluntary updates to professional society guidelines is insufficient.
- Further interventions, either grassroots or regulatory, are needed for complete unification.
