(Agencies)
Updated: 2008-01-24 15:28

Major hospitals and neurological centers across America use different protocols for determining brain death, and often stray from standards established by the American Academy of Neurology, a recent survey reveals.

The results, which will be published in the January 22 issue of the journal Neurology, are based on surveys of top neurology and neurosurgery centers identified by US News and World Report.

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

First established in the 1960s, the concept of brain death refers to the irreversible loss of function in the entire brain. In 1981, a Presidential Commission confirmed that brain death met the legal requirements of more traditional standards, such as when a person's heart and lungs stop functioning.

Greer and his collaborators evaluated institutional guidelines for determining brain death from 38 of the top 50 neurology and neurosurgery programs, listed in the US News 2006 Best Hospitals issue. They had contacted all 50 institutions. Out of the 41 respondents, three had no written guidelines at all.

The neurologists found significant differences among the hospitals, with several discrepancies from the AAN guidelines. For instance, some hospitals' guidelines deviated on AAN specifications regarding the specialty and level of training required for physicians tasked with determining brain death.

In addition, the institutions differed on medical conditions that needed to be met before specific testing took place and the type and timing of examinations used to determine brain death.

The researchers urge a revamping of AAN guidelines so hospitals have clear principles for brain-death determination.