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Determination of brain death in children--a medicial center experience
Wen-Hsin Tsai1, Wang-Tso Lee, Kun-Long Hung
1Department of Pediatrics, Buddhist Tzu Chi General Hospital Taipei Branch, Taipei, Taiwan.
Insights
This study analyzed 18 pediatric patients diagnosed with brain death using 1987 guidelines. Organ procurement was successful in all cases, suggesting guideline applicability in children over three years old.
Area of Science:
- Pediatric critical care medicine
- Neurology
- Organ donation and transplantation
Background:
- Determining brain death in children requires adherence to specific diagnostic criteria.
- Previous studies have focused on adult populations, with limited data on pediatric brain death determination.
Purpose of the Study:
- To evaluate the application of 1987 brain death determination guidelines in pediatric patients.
- To assess the outcomes of organ procurement in children declared brain dead.
Main Methods:
- Retrospective review of an organ donation team's database from 1988-2003.
- Inclusion of 18 pediatric patients (<18 years) meeting brain death criteria.
- Analysis of primary diagnosis, observation period, clinical findings, and apnea test results.
Main Results:
- The average age of diagnosis was 13 years and 8 months.
- Head injuries were the most common cause (82%), followed by hypoxic ischemic encephalopathy, intracranial hemorrhage, and brain tumors.
- Solid organ procurement was successful in 100% of cases.
Conclusions:
- The 1987 brain death determination guidelines appear appropriate for children over three years old in Taiwan.
- Further research is needed to clarify the role of electroencephalography and cerebral blood flow measurements in younger children.
- Successful organ procurement highlights the importance of timely and accurate brain death diagnosis in pediatric patients.
Abstract:
We retrospectively reviewed our organ donation team's database (timeframe: 1988-2003) identifying 18 patients under 18 years old meeting criteria for the diagnosis of brain death. We emphasized the primary diagnosis, observation period, physical findings, neurological findings, and the apnea test results according to the 1987 guidelines for brain death determination. The average age at diagnosis was 13 years and 8 months old (range: 3 months-18 years; median: 16 years). Fifteen children (82%) suffered head injuries; one (6%) had hypoxic ischemic encephalopathy; one (6%) suffered intracranial hemorrhage; and one (6%) had a brain tumor. The average observation period from clinical suspicion of brain death to the brain death test was 146 hours (range: 16-1416 hours; median: 72 hours). Among the 18 patients fulfilling the criteria, brain death was declared after two successful apnea tests performed at least 4 hours apart (average: 6 hours; range: 4-18 hours). Solid organ procurement was successful in all patients (100%). Use of the guidelines for determining brain death in children is limited in Taiwan; however, we found that the previously used guidelines in Taiwan might be appropriate for children above 3 years old, although further study is necessary to determine the roles of electroencephalography and cerebral blood flow measurement in younger children.
