Friday, October 3, 2008
My leading candidate for headline of the decade is "Are You Brain Dead? Depends on the Hospital." It is from a news article reporting on a study in Neurology (one of the few studies in the entire medical oeuve of 2008 that we have not blogged on). The study authors surveyed the "Top 50" neurology centers in the United States, as ranked by US News & World Reports, on their institutional guidelines for establishing brain death. Three of the 41 responding institutions do not have guidelines. Of the 38 that do, there was considerable variation in the criteria for determining brain death and more-than-expected variance from the guidelines established by the American Academy of Neurology in 1995 and reaffirmed as recently as 2007. It should be noted that 2008 is the 40th anniversary of the recommendation & criteria for using brain death in potential organ donor situations.
Joining the conversation is Economist.com with "O death, when is thy sting?" The tab label on the web page asks provocatively, 'When, exactly, are you dead?' They point out that in the UK the emphasis is on loss of brainstem function, while in the US whole-brain function is evaluated. The fact that death is defined in varying ways is not new. In serious trauma, on the battlefield, and in expected deaths from advanced disease there is nothing obsolete about using the cessation of heartbeat and respirations as the determinant of deadness.