To review Brain Death Declaration within a hospital system to determine if the patient consistently meets Â鶹´«Ã½Ó³»­ Guidelines for determining brain death.

Patients whom suffer from a devastating neurologic injury such as intracranial hemorrhage, malignant ischemic stroke, or cardiac arrest resulting in anoxic brain injury will often progress to brain death given natural progression of injury. Determining Brain Death not only varies by state but also across hospital systems. This variability lends to patients prematurely declared as brain dead when not all prerequisite criteria were met.

Retrospective chart review of 773 patients referred to Life Alliance for Organ Donation with evidence of severe brain injury defined as GCS <6 and ventilated over a 6 month time period.

Out of 773 patients, 34 were declared brain dead. 22 (64.7%) fulfilled prerequisite and diagnostic guidelines as set by Â鶹´«Ã½Ó³»­ and state for determination of brain death. Of the 12 (35.3%) patients who did not, most were from absence of second physician exam (7 (58.3%)), presence of underlying metabolic derangements (4 (33.3%)), and hypothermia (2 (16.7%)). Of the 11 whom were too unstable for apnea testing, most were subsequently confirmed with ancillary TCD (9 (81.8%)). Only 13/34 (38.2%) had documentation supporting diagnostic criteria had been met.

Variations in provider specialty, hospital unit, and patient not meeting prerequisites for determining brain death results in patients receiving an inappropriate declaration of Brain Death until ancillary testing obtained. Consistency in accurate declaration and documentation of Brain Death when prerequisite criteria met improved to 17/21 (80.9%) when either Neurology or Neurosurgery were the primary team and patient admitted to the Neuroscience ICU. Implementation of a standardized method for Brain Death determination including meeting prerequisite criteria, proper documentation, and provider education will result in more accurate and timely declaration across the hospital system.