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Verification of Death by Neurologic Criteria: A Survey of 12 Organ Procurement Organizations Across the United States

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Abstract

Background

The Center for Medicare and Medicaid Services requires Organ Procurement Organizations (OPOs) to verify and document that any potential organ donor has been pronounced dead per applicable legal requirements of local, state, and federal laws. However, OPO practices regarding death by neurologic criteria (DNC) verification are not standardized, and little is known about their DNC verification processes. This study aimed to explore OPO practices regarding DNC verification in the United States.

Methods

An electronic survey was sent to all 57 OPOs in the United States from June to September 2023 to assess verification of policies and practices versus guidelines, concerns about policies and practices, processes to address concerns about DNC determination, and communication practices.

Results

Representatives from 12 OPOs across six US regions completed the entire survey; 8 of 12 reported serving > 50 referral hospitals. Most respondents (11 of 12) reported comparing their referral hospital’s DNC policies with the 2010 American Academy of Neurology Practice Parameter and/or other (4 of 12) guidelines. Additionally, most (10 of 12) reported independently reviewing and verifying each DNC determination. Nearly half (5 of 12) reported concerns about guideline-discordant hospital policies, and only 3 of 12 thought all referral hospitals followed the 2010 American Academy of Neurology Practice Parameter in practice. Moreover, 9 of 12 reported concerns about clinician knowledge surrounding DNC determination, and most (10 of 12) reported having received referrals for patients whose DNC declaration was ultimately reversed. All reported experiences in which their OPO requested additional assessments (11 of 12 clinical evaluation, 10 of 12 ancillary testing, 9 of 12 apnea testing) because of concerns about DNC determination validity.

Conclusions

Accurate DNC determination is important to maintain public trust. Nearly all OPO respondents reported a process to verify hospital DNC policies and practices with medical society guidelines. Many reported concerns about clinician knowledge surrounding DNC determination and guideline-discordant policies and practices. Educational and regulatory advocacy efforts are needed to facilitate systematic implementation of guideline-concordant practices across the country.

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Funding

There are no funding sources for the study.

Author information

Author notes

  1. Kasra Sarhadi, Kristopher Hendershot, Ariane Lewis and Sarah Wahlster have been contributed equally to this work.

Authors and Affiliations

  1. University of Washington, Seattle, WA, USA

    Kasra Sarhadi, Kristopher A. Hendershot, Natalie Smith, Michael Souter, Claire Creutzfeldt, Abhijit Lele & Sarah Wahlster

  2. University of Florida, Gainesville, FL, USA

    Carolina Maciel & Katharina Busl

  3. University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Julius Balogh

  4. Boston University School of Medicine, Boston, MA, USA

    David Greer

  5. NYU Langone Medical Center, New York, NY, USA

    Ariane Lewis

Authors
  1. Kasra Sarhadi
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  2. Kristopher A. Hendershot
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  3. Natalie Smith
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  4. Michael Souter
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  5. Claire Creutzfeldt
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  6. Abhijit Lele
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  7. Carolina Maciel
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  8. Katharina Busl
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  9. Julius Balogh
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  10. David Greer
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  11. Ariane Lewis
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  12. Sarah Wahlster
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Contributions

All authors had full access to all of the data and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors contributed substantially to the study design, data acquisition and analysis, as well as interpretation. Drs. Sarhadi, Hendershot, Wahlster, and Lewis wrote the manuscript, and all authors edited the manuscript. The final manuscript reviewed and approved by all authors.

Corresponding author

Correspondence to Kasra Sarhadi.

Ethics declarations

Conflict of interest

Author AVL reports salary support from LifeCenter Northwest. The University of Washington receives salary support for author MJS from LifeCenter Northwest.

Ethical Approval/Informed Consent

This study adhered to ethical guidelines and was approved by the University of Washington Human Subjects Division, with institutional review board approval before initiation.

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Sarhadi, K., Hendershot, K.A., Smith, N. et al. Verification of Death by Neurologic Criteria: A Survey of 12 Organ Procurement Organizations Across the United States. Neurocrit Care (2024). https://doi.org/10.1007/s12028-024-02001-6

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