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Chances that a patient may recover have to be completely null and void in order for brain death to be declared.
Even though national guidelines regarding this type of death have been agreed upon, brain death diagnostic differs depending on hospital policies, bringing down the percentage of accuracy concerning this phenomenon accordingly. This is rather disconcerting because if this scenario occurs, due to the fact that having 100% accuracy is of the utmost importance, to say the least.
Although, until the present time, no brain death diagnostics have been made despite the patient being alive, there is still the 1% chance that a patient might be declared brain dead when he is actually not. Because of this, lead researcher Dr. David Greer from the Yale School of Medicine in Connecticut has created a guideline for carrying out the test that eventually declares the patient dead.
This created standard, even if extremely efficient and easy to use, has still yet to be adopted by several hospitals across the US despite the fact that it is now considered a national guideline. In order to see how this process was adopted by the hospitals and clinics in the country, 508 facility guidelines were reviewed by Dr. Greer and his team of researchers.
Out of the reviewed group, 56% hospital policies rule out hypotension when declaring a patient brain dead. Extremely low blood pressure, the aforementioned hypotension, is one of the factors that can create the illusion that patient may be suffering from the death of his brain.
Hypothermia is also one of these factors, but it is not ruled out by 20% of the hospitals from the review group. This is rather disconcerting, even if no cases where the patient was declared dead, when he still regained some of his brain functions, due to hypothermia, have surfaced.
Because breathing is a body function controlled by the brain, the research team was surprised by the fact that 10% of hospitals do not require doctors to perform an apnea test (testing if the patient can breathe on his or her own) when declaring brain death. This test is considered to be an absolute requirement when making this diagnostic.
Declaring brain death is required to be extremely accurate in order to see if there still exists a possibility that through prolonged treatments or through the elimination of an unknown factor, the patient may regain some of his or her brain functions. By having just the 1% chance that a diagnostic may be false, it could greatly impact organ donation.
Policies differ from hospital to hospital due to various factors, ranging from community beliefs to state laws. This is why by publishing an article, regarding the national standard regarding brain death, in the journal JAMA Neurology, the team hopes that more hospitals will adhere to the national guideline.
Although a brain death diagnostic differs depending on hospital policies, this would no longer be the case if the national standard would be enforced by the Joint Commission which accredits hospitals. This is due to the fact that whatever the commission body declares to be a standard, it is immediately taken into effect across all hospitals and clinics, without any policy differences between them.
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