Report prompts protocols for diagnosis of brain death

Standardizing the tests used to determine brain death may increase family confidence in the diagnosis, which in turn could lead to increased organ donations.

By Andis Robeznieks, AMNews staff. Oct. 14, 2002.

A neurosurgeon at Los Angeles County General Hospital acknowledges that his recently published report on brain-death diagnosis may have reduced organ donations there in the short term. But he believes the temporary setback is needed to accomplish a greater good.

After reviewing the 78 brain deaths documented at the hospital in 1999, J. Peter Gruen, MD, and colleagues at the Keck School of Medicine of the University of Southern California in Los Angeles, discovered that the diagnosis was highly variable and concluded that standards for practice and documentation were sorely needed.

"I've had to apologize to everyone in my institution because it didn't make us look good, but I believe it was the right thing to do," Dr. Gruen said. "It's a global problem and needs to be brought to the attention of all the institutions that are doing just about as bad a job as we were. Something that is so very important to patients and their families is being done in this haphazard, unstructured, and unregulated way."

According to the report, published in the September issue of Neurosurgery, 78 brain-death declarations were made at the hospital in 1999; complete charts were available for 58. The review of brain-death notes revealed that pupillary tests were done in 86% of the cases, gag reflexes in 78%, motor response tests in 66%, and corneal reflexes in 57%.

The report acknowledges that some incomplete assessments are undoubtedly the result of cases where there is no uncertainty that brain death had occurred, but it noted that certain tests are specifically recommended in order to rule out any other causes of impaired consciousness. [...]