title: Practice variability in brain death determination: a call to action.
abstract: OBJECTIVE
  To characterize the present state of brain death (BD) determination in actual practice relative to contemporary American Academy of Neurology (AAN) guidelines.
  
  
  METHODS
  We reviewed the charts of all adult (16 years and older) BD organ donors during 2011 from 68 heterogeneous hospitals in the Midwest United States. Data were collected across 5 categories: guideline performance, preclinical testing, clinical examination, apnea testing, and use of ancillary tests. Practice within categories and overall adherence to AAN guidelines were assessed.
  
  
  RESULTS
  Two hundred twenty-six BD organ donors were included. Practice exceeded recommendations in guideline performance but varied widely and deviated from AAN guidelines in all other categories. One hundred two (45.1%) had complete documentation of brainstem areflexia and absent motor response. One hundred sixty-six (73.5%) had completed apnea testing. Of the 60 without completed apnea testing, 56 (93.3%) had ancillary tests consistent with BD. Overall, 101 (44.7%) strictly and 84 (37.2%) loosely adhered to contemporary AAN guidelines.
  
  
  CONCLUSIONS
  There is wide variability in the documentation of BD determination, likely reflecting similar variability in practice. This is a call for improved documentation, better uniformity of policies, and comprehensive and strategically targeted educational initiatives to ensure consistently contemporary approaches to BD determination in every patient.
authors.affiliation: From the Pritzker School of Medicine (C.N.S., M.S.), University of Chicago; and Department of Neurology (J.I.F., K.H., F.G., A.A.), University of Chicago Medicine, IL.
authors.forename: Claire N
authors.initials: CN
authors.lastname: Shappell
authors.forename: Jeffrey I
authors.initials: JI
authors.lastname: Frank
authors.forename: Khalil
authors.initials: K
authors.lastname: Husari
authors.forename: Matthew
authors.initials: M
authors.lastname: Sanchez
authors.forename: Fernando
authors.initials: F
authors.lastname: Goldenberg
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Ardelt
mesh_terms: D000328:Adult; D001926:Brain Death / Q000175:diagnosis*; D015331:Cohort Studies; D005260:Female; D006761:Hospitals / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards*; D012189:Retrospective Studies; D014019:Tissue Donors