Top hospitals typically disregard brain-death guidelines

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 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.

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5 Comments

  1. As a Neurologist, I made detailed outlines for Brain Death criteria available for the ICU but they weren’t followed even by my own colleagues. The criteria are quite complex and sometimes difficult to do. I was pressured into not “going by the book” by the Organ Procurement Team. They thought I was working against them. They were more concerned about procuring good organs rather than meeting the criteria for Brain Death–especially the repeat testing in 24 hours gave them a lot of angst. Also, if criteria were not met, they nonetheless expected a declaration of Brain Death and expected me to overlook those minor details. They (the Organ Procurers) also had procedures and lab work done, like a bronchoscopy, on the patient to evaluate suitability of organs before the patient was legally dead. The other weird thing, was that the average clinician would still document the “time of death” when the patient was taken off the respirator even though the patient was declared “Brain Dead” earlier and I had signed the Death Certificate. As a Neurologist I think the whole clinical concept of “Brain Death” is quite messy.

  2. Now more than ever, there is great push to kill for organs. Go to http://www.myfoxny.com and search for movie clip using words: organ donation controversy. This young man did NOT have strokes. Get the picture? The organ transplantation and everything derived from it has been based on lies. “Brain death” and it’s definition was CREATED for transplantation and criteria for pronouncing brain death has been changed at least 30 times since making it easier and easier to pronounce. Now, much push has been to kill the young by DCD. The patients and family are in the dark to all of what is going on. And through the family’s trust, their loved one is killed for someone else’s profit and other gains. Shame on the medical field for knowing and not protecting, shame on the transplantation organizations for valuing money over an innocent injured persons life. Shame on the US government for allowing and even encouraging. This young man would have lived but the evil powers made sure he would not. I know the truth.

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