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.