Brain death documentation: Analysis and issues

OBJECTIVE: Specific guidelines for documenting the complete loss of brain function, for the declaration of brain death, have been established for 3 decades. This study assessed the quality and completeness of brain death notes and the effects of delays between notes on organ procurement. METHODS: A retrospective review of brain death declarations at a major medical center was performed. Fifty-eight cases, with a total of 121 brain death notes, were identified in a 12-month period. Notes were assessed for clinical and confirmatory tests of brain and brainstem function. Adverse physiological events that occurred in the time intervals between notes were also identified. RESULTS: The clinical tests most likely to be documented were tests of pupillary (86%) and gag (78%) reflexes. Corneal reflexes were tested in only 57% of cases, and motor responses were noted in only 66%. Documentation by the neurosurgery department was generally more complete. The delays between brain death declarations were highly variable but did not result in any loss of donor organs because of hemodynamic derangements. CONCLUSION: To meet the needs of organ recipients and donor families and to comply with hospital, legal, and legislative mandates, hospitals may need to increase quality assurance activities with respect to declarations of brain death. Increased physician education should improve awareness of uniform brain death declaration guidelines.