To the Editor Greer et al1 analyzed compliance of hospital protocols on brain death (BD) determination with the 2010 American Academy of Neurology (AAN) guidelines. They posited that this neurologic standard is 100% accurate. We comment on the accuracy claim.
First, accuracy is judged by resumption of a specific set of ceased neurologic functions within a predefined short timeline. Longer waiting times negatively affect organ donation. However, the irreversibility timeline of BD findings has not been scientifically established. The eventual outcome is terminal organ procurement or treatment withdrawal, but, although resulting in a 100% death rate, inherently confounds the reported accuracy or false-positive rate. Indeed, false-positive cases are generally reported when court orders support families’ request for prolonged life-support treatment. The McMath2 and Hailu3 cases are examples.
Rady MY, Verheijde JL. American Academy of Neurology Guidelines and the Neurologic Determination of Death. JAMA Neurol. 2016;73(6):760-761. doi:10.1001/jamaneurol.2016.0428