Management of non-survivable head trauma: Opportunities for improvement

Abstract

Background Managing patients with non-survivable head trauma who do not meet brain death criteria presents significant ethical and clinical challenges. Decisions frequently fall to surrogates with limited guidance, particularly when organ donation status is unknown. This study assessed physician perspectives on communication, interventions, and institutional factors. Methods We conducted a national survey of academic neurosurgery, trauma surgery, and neurocritical care programs. Items examined communication barriers, interventions by donor status, institutional support, and a dissonance measure for interventions viewed as inappropriate. Results A total of 133 physicians responded. Top communication barriers were medical literacy, unclear patient values, and intrafamily conflict. Physicians offered more interventions when donor status was unknown than when patients were confirmed non donors. Lack of institutional support was associated with higher dissonance scores. Conclusion Care varies widely and is influenced by donor status and institutional culture, underscoring the need for clearer guidance and provider support.