Monday, January 28, 2008

The Need for Uniform Criteria to Declare Death by Neurological Criteria

I have written several posts about the need to develop uniform standards of declaring death by neurological criteria--popularly known as "brain death." Now, there's some more information out about that problem. From the story:

Guidelines for determining brain death differ substantially between major U.S. hospitals, a national survey shows, and few stick to parameters established by the American Academy of Neurology.

"There are substantial differences in practice that may have consequences for the determination of death and initiation of transplant procedures," Dr. David M. Greer, at Massachusetts General Hospital in Boston, and colleagues report in the medical journal Neurology.

Greer's team requested guidelines from hospitals named as having the top 50 neurology programs in the nation in 2006 by US News and World Report. Only 42 percent of the hospitals required that a neurologist or neurosurgeon perform the examination for brain death, results showed. Among the 71 percent that stipulated multiple examinations, the time required between examinations varied from 1 to 24 hours. Furthermore, the authors point out, "It was surprising to find that the cause of brain death was not stipulated in a large number (37 percent) of guidelines."

This is a very serious matter. The trust of the American people depends on getting this most fundamental matter right.

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4 Comments:

At January 29, 2008 , Blogger Scott said...

I agree that this is a serious matter. But even more serious is that fact that as brain death continues to lose its scientific credibility as representative of the death of the organism as a whole, defenders of the brain death criterion are now opting to its use to confirm the permanent loss of consciousness. This constitutes a change in the definition of death.

 
At January 29, 2008 , Blogger Jason Dulle said...

How subjective is the diagnosis of brain death? How is it determined?

 
At January 30, 2008 , Blogger Scott said...

It depends on what you mean by subjective. Consider this, today there are over 40 different sets of criteria from which physicians may choose to diagnose brain death. Does that sound like it reflects a uniform understanding of the concept?

 
At January 30, 2008 , Blogger Wesley J. Smith said...

Scott: Good point. Those minimal criteria need to be established, defended, and required. The current ad hoc approach is no longer acceptable.

IF death by neurlogical criteria can no longer be defended, that needs to be determined, too.

 

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