News of the Day ... In Perspective

Top hospitals typically disregard brain-death guidelines

Many highly regarded hospitals in the U.S. routinely diagnose brain death without following the guidelines promulgated in 1995 by the American Academy of Neurology (AAN), according to a survey presented at the American Neurological Association (ANA) annual meeting (Kurt Samson, Neurology Today 11/6/07).

Researchers at the Massachusetts General Hospital surveyed the top 50 neurology and neurosurgery departments nationwide; 82 percent responded. Results showed that �adherence to the AAN guidelines varied widely, leading to major differences in practice, which may have consequences for the determination of death and initiation of transplant procedures,� said Dr. David Greer.

Apnea testing was omitted by 27 percent; still more distressing is that many fail to even check for spontaneous respirations.

�We�re hoping to present a persuasive case for new standards,� said Dr. David Greer.

�In plain, straight talk,� writes Dr. Lawrence Huntoon, editor-in-chief of the Journal of American Physicians and Surgeons, �the survey indicates a high likelihood that some patients are being �harvested� in some hospitals before they are dead! In hospitals with aggressive transplant programs (hospitals make a huge amount of money on transplant cases), making sure a patient is dead before going to the �harvesting suite� may be viewed as a minor technicality/impediment.�

In another poster at the AAN conference, Dr. Eelco Wijdicks reported that the �physical deterioration of brain matter once referred to as �respirator brain� has become an anomaly in today�s �modern transplant era��where temperature and other variables of new cadavers must be carefully monitored and controlled to keep organs viable.�

In the past, he noted, patients had often been kept on respirators for weeks, and their brains [but apparently not their livers] had turned to liquid.

These days, microscopic analysis may be needed to detect the changes. �Variable neuronal loss was noted in the brain and brainstem samples, but total necrosis was rarely observed��because of �earlier preservation of the brain and more efficient organ harvesting programs.�

�It�s just a matter of basic pathology that needs to be recognized in this era of transplantation,� said Dr. James Bernat, professor of neurology at Dartmouth.

Additional information:

• Brain death and organ transplantation