title: Improving uniformity in brain death determination policies over time.
abstract: To demonstrate that progress has been made in unifying brain death determination guidelines in the last decade by directly comparing the policies of the US News and World Report's top 50 ranked neurologic institutions from 2006 and 2015.
  
  
  
  We solicited official hospital guidelines in 2015 from these top 50 institutions, generated summary statistics of their criteria as benchmarked against the American Academy of Neurology Practice Parameters (AANPP) and the comparison 2006 cohort in 5 key categories, and statistically compared the 2 cohorts' compliance with the AANPP.
  
  
  
  From 2008 to 2015, hospital policies exhibited significant improvement (p = 0.005) in compliance with official guidelines, particularly with respect to criteria related to apnea testing (p = 0.009) and appropriate ancillary testing (p = 0.0006). However, variability remains in other portions of the policies, both those with specific recommendation from the AANPP (e.g., specifics for ancillary tests) and those without firm guidance (e.g., the level of involvement of neurologists, neurosurgeons, or physicians with education/training specific to brain death in the determination process).
  
  
  
  While the 2010 AANPP update seems to be concordant with progress in achieving greater uniformity in guidelines at the top 50 neurologic institutions, more needs to be done. Whether further interventions come as grassroots initiatives that leverage technological advances in promoting adoption of new guidelines or as top-down regulatory rulings to mandate speedier approval processes, this study shows that solely relying on voluntary updates to professional society guidelines is not enough.
authors.affiliation: From the Department of Neurology (H.H.W., D.M.G.), Yale University School of Medicine, New Haven, CT; Department of Neurology (P.N.V.), Henry Ford Hospital, Detroit, MI; Department of Neurology (G.V.H.), Harvard Medical School, Cambridge, MA; and Department of Neurology (E.F.M.W.), Mayo Clinic, Rochester, MN.
authors.forename: Hilary H
authors.initials: HH
authors.lastname: Wang
authors.affiliation: From the Department of Neurology (H.H.W., D.M.G.), Yale University School of Medicine, New Haven, CT; Department of Neurology (P.N.V.), Henry Ford Hospital, Detroit, MI; Department of Neurology (G.V.H.), Harvard Medical School, Cambridge, MA; and Department of Neurology (E.F.M.W.), Mayo Clinic, Rochester, MN.
authors.forename: Panayiotis N
authors.initials: PN
authors.lastname: Varelas
authors.affiliation: From the Department of Neurology (H.H.W., D.M.G.), Yale University School of Medicine, New Haven, CT; Department of Neurology (P.N.V.), Henry Ford Hospital, Detroit, MI; Department of Neurology (G.V.H.), Harvard Medical School, Cambridge, MA; and Department of Neurology (E.F.M.W.), Mayo Clinic, Rochester, MN.
authors.forename: Galen V
authors.initials: GV
authors.lastname: Henderson
authors.affiliation: From the Department of Neurology (H.H.W., D.M.G.), Yale University School of Medicine, New Haven, CT; Department of Neurology (P.N.V.), Henry Ford Hospital, Detroit, MI; Department of Neurology (G.V.H.), Harvard Medical School, Cambridge, MA; and Department of Neurology (E.F.M.W.), Mayo Clinic, Rochester, MN.
authors.forename: Eelco F M
authors.initials: EF
authors.lastname: Wijdicks
authors.affiliation: From the Department of Neurology (H.H.W., D.M.G.), Yale University School of Medicine, New Haven, CT; Department of Neurology (P.N.V.), Henry Ford Hospital, Detroit, MI; Department of Neurology (G.V.H.), Harvard Medical School, Cambridge, MA; and Department of Neurology (E.F.M.W.), Mayo Clinic, Rochester, MN. david.greer@yale.edu.
authors.forename: David M
authors.initials: DM
authors.lastname: Greer
mesh_terms: D001926:Brain Death / Q000175:diagnosis*; D015331:Cohort Studies; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006761:Hospitals / Q000592:standards; D006801:Humans; D057766:Policy; D017410:Practice Guidelines as Topic / Q000592:standards; D014481:United States