A Survey to Determine the Understanding of the Conceptual Basis and Diagnostic Tests Used for Brain Death by Neurosurgeons in Canada

Abstract

Within the neurosurgical community, a stand-alone concept of BD does not exist. There is also significant variability in the understanding of the tests that are compatible with the criterion of BD.

A Survey Of American Neurologists About Brain Death: Understanding Of The Conceptual Basis And Diagnostic Tests For Brain Death

“…The strengths of the survey include the development methodology, and unambiguous nature of most of the questions. In addition, the striking similarity of our results to those of other surveys done in the past, including using this same survey in different populations of North American nonneurologist medical specialists, enhances the generalizability of the results [12,13,[22][23][24]. The preponderance of evidence from this survey, and other surveys, support the conclusions we have drawn.…”

“…The development and initial testing of the instrument are described in more detail elsewhere [12,13]. The current instrument (Additional File 1) is identical to that used in a survey of Canadian pediatric intensivists and Canadian neurosurgeons, with the following changes: (a) in the first question about acceptable conceptual reasons to explain BD, we added the choice "cessation of the vital work of a living organism-the work of self preservation, achieved through the organism's need driven commerce with the surrounding world" as stated by the President's Council; and (b) we modified the scenario regarding family refusal to stop "life support" in a braindead patient to describe continued support for 8 months until ventilator withdrawal, and asked "was this patient dead for the last 8 months?"…”

Brain death, states of impaired consciousness, and physician-assisted death for end-of-life organ donation and transplantation

“…The absence of neuropathologic findings of profound brain stem ischemia can suggest reversible causes of coma or perhaps retained neurological activity undetected by clinical examination (Walker 1978). In a Canadian survey, 46% of neurosurgeons considered the absence of moderate structural damage in both the brain stem and cerebral cortex on brain autopsy to be incompatible with a clinical determination of brain death (Joffe et al 2007). More than one-third of the neurosurgeons surveyed also considered that some blood flow to the brain or a brain stem with minimal microscopic damage is incompatible with a clinical determination of brain death.…”

Radionuclide Evaluation of Brain Death in the Post-McMath Era

“…Reviews of the current medical literature periodically appear (13)(14)(15)(16), and updated guidelines have been issued by professional societies (17)(18)(19)(20)(21). Despite these resources, surveys have repeatedly shown that many physicians exhibit a poor understanding of the underlying concepts (22,23) and that even carefully formulated practice guidelines are inconsistently adopted (7,(24)(25)(26), indicating a persistent gap in knowledge and training (27,28). The topic of brain death has entered into the public's consciousness, albeit in a distorted manner (29,30); physicians must therefore contend with families' erroneous notions, which are based, at least in part, on inaccurate or sensational media reports (31).…”