Brain death is generally defined as irreversible coma with absent brainstem reflexes. Ten years ago, Eelco Wijdicks of the Mayo Clinic in Rochester, Minnesota, compared criteria for brain death in 80 countries and found widespread variability in the methods used. Of the 70 countries that had published guidelines, 59 per cent required a test to see if the person could breathe unassisted, while half required more than one doctor to examine the patient. Extra tests, like an EEG, were required in 40 per cent of countries.
Even within the US, guidelines can vary. "Each state and each individual hospital can develop their own guidelines," says David Greer of Yale University. He compared guidelines between 50 top US hospitals and found differences in the attention paid to confounding factors and how they assessed patients' ability to breathe unaided (Neurology, DOI: 10.1212/01.wnl.0000296278.59487.c2). Even if international consensus can't be reached, a national standard on brain death is needed, says Greer. "You have people using outdated guidelines and there can be misdiagnosis, our worst nightmare."
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