Variability among hospital policies for determining brain death in adults

Objective: In the absence of federal requirements or state statutes, criteria to certify brain death are specified by medical staff and administrative policies in individual hospitals. Variability among such policies may allow inconsistency in the declaration of death by neurologic criteria. Our intent was to partially quantify diversity among hospital standards used in brain death certification. Design: Survey. Setting: Six hundred randomly selected hospitals. Patients: None. Interventions: A survey was conducted of 600 hospitals randomly selected from the American Hospital Association registry representing 200 hospitals each of <300 beds, 300-500 beds, and >500 beds. One hundred six policies submitted by these institutions comprised the final study group. Policies were reviewed for criteria of interest and were compared against variables recommended by the American Academy of Neurology. Measurements and Main Results: Significant variability in policy criteria was found compared with the American Academy of Neurology and other authoritative standards. Differences were greatest in specifying conditions to be excluded before testing and in specific testing methods during a detailed physical examination. The few differences noted between larger vs. smaller hospitals most likely reflect greater availability of resources in larger institutions. Conclusions: Differences among hospital policies for certification of brain death may permit variability among hospitals throughout the United States in the pronouncement of death by neurologic criteria. Standardisation and enforcement of polices that ensure the highest possible accuracy should be considered.