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Is That Patient Really Brain Dead?

Declaring a patient brain dead shouldn’t be up for debate. Doctors and hospitals should be certain before declaring someone functionally deceased. But a new study shows that in most U.S. hospitals, brain death is a matter of interpretation.

You rush to the emergency room after learning a loved one has been in a terrible car crash. The doctors do everything they can to revive your family member, but in the end, the hospital staff declares him brain dead. You would want them to be sure. There should be absolutely no chance of recovery before deciding to withdraw treatment.

That’s why in 2010, neurologist David Greer, from the Yale University School of Medicine, partnered with other medical experts to come up with guidelines. Before a doctor declares a person brain dead, she should:

  • Perform a clinical evaluation;
  • Determine the cause of the coma is irreversible (and that it is not caused by a drug or medication);
  • Bring the patient’s core temperature into normal range;
  • Regulate the patient’s blood pressure;
  • Perform a neurological evaluation;
  • Test for responsiveness and reflexes;
  • Test for responsive breathing;
  • Perform brain scans and tests like MRIs and CAT scans; and
  • Document everything in the medical record.

But five years later, Dr. Greer is disappointed to find that most hospitals aren’t following that standard. He told NPR:

“This is truly one of those matters of life and death, and we want to make sure this is done right every single time. . . . The worst-case scenario would be if we were to pronounce somebody brain-dead and then they recovered some neurological function. . . . That would be horrific if that were the case.”

And yet, at the 492 hospitals and health care systems he surveyed across the country, there was anything but consistency.

For example, more than 20% of hospitals don’t require patients to be brought up to normal temperatures. When patients’ bodies remain cold it can suppress neurological activity and lead doctors to falsely determine brain death. Nearly half skip regulating patients’ blood pressure.

Now Greer is calling for change.

“There really are no excuses at this point for hospitals not to be able to do this 100 percent of the time.”

Many other medical professionals are echoing the call. They are calling the survey results “unconscionable” and “disturbing.”

Dr. John Combes, chief medical officer at the American Hospital Association, told NPR in a statement that hospitals “work hard to reflect various national-based guidelines, as well as state and local regulations, as well as consulting multi-disciplinary advisory committees, in this very complicated arena.”

But inconsistent brain death policies could raise concerns over whether your loved one is really brain dead. It could make you question his care, and even your own decisions. You need to know your family member is receiving the best care.

David Christensen is a brain injury expert at Christensen Law in Southfield, Michigan. He represents the families of fatal car accident victims. If you have lost a loved one to brain death, contact Christensen Law today for a free consultation.