Objective:

To describe the establishment of a multidisciplinary Brain Death Quality Improvement (BDQI) committee to align local policy with national guidelines, standardize brain death determination practices among providers, improve adherence to institutional brain death policy, and provide education.

Background:

There is well-documented variability in brain death/ death by neurologic criteria (BD/DNC) determination both within and between institutions, leading to inconsistencies in practice and documentation. Recent guidelines from the American Academy of Neurology and international consensus statements emphasize the need for standardized protocols and adherence to up-to-date national guidelines to ensure accurate and consistent determination of BD/DNC and to maintain public trust.

Design/Methods:

A multidisciplinary BDQI committee was formed, including physicians (neurology, neurosurgery, neurocritical care, medical critical care, surgical critical care, and radiology [nuclear medicine]); nurses; and representatives from respiratory therapy, pharmacy, ECMO, social work, and ethics. The committee systematically reviews cases of BD/DNC, develops clinical tools, updates/maintains the local brain death policy, and provides education. The QI processes include case review, individualized provider feedback, quarterly case summaries, and modifications to policies and protocols to address identified issues.

Results:

Since inception in January 2023, through June 2025, the BDQI committee has reviewed 66 cases. Ancillary testing was performed in 10 patients (15%) and 6 (9%) patients were treated with ECMO. Case review has led to revision of apnea test documentation, standardization of nuclear medicine ancillary testing, and development of a process for nuclear medicine flow studies on weekends. 

Conclusions:

Implementation of a multidisciplinary BDQI committee led to improved standardization of brain death determination, enhanced adherence to institutional policies, and greater alignment with current specialty guidelines. Ongoing efforts will focus on monitoring protocol deviations and developing strategies and interventions to improve adherence.