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Published on: April 17, 2020
Determination of death by neurologic criteria around the world
Ariane Lewis1, Azza Bakkar2, Elana Kreiger-Benson2
1From the NYU Langone Medical Center (A.L.); NYU School of Medicine (A.B., E.K.-B., A.K., J.L.), New York; Montreal Children's Hospital (S.D.S.), McGill University, Quebec; Canadian Blood Services (S.D.S., S.T.), Ottawa, Ontario; LAC and USC Medical Center (G.S.), Los Angeles, CA; and Boston University School of Medicine (D.G.), MA. ariane.kansas.lewis@gmail.com.
Objective:
To identify similarities and differences in protocols on determination of brain death/death by neurologic criteria (BD/DNC) around the world.
Methods:
We collected and reviewed official national BD/DNC protocols from contacts around the world between January 2018 and April 2019.
Results:
We communicated with contacts in 136 countries and found that 83 (61% of countries with contacts identified, 42% of the world) had BD/DNC protocols, 78 of which were unique. Protocols addressed the following prerequisites and provided differing instructions: drug clearance (64, 82%), temperature (61, 78%), laboratory values (56, 72%), observation period (37, 47%), and blood pressure (34, 44%). Protocols did not consistently identify the same components for the clinical examination of brain death; 70 (90%) included coma, 70 (90%) included the pupillary reflex, 68 (87%) included the corneal reflex, 67 (86%) included the oculovestibular reflex, 64 (82%) included the gag reflex, 62 (79%) included the cough reflex, 58 (74%) included the oculocephalic reflex, 37 (47%) included noxious stimulation to the face, and 22 (28%) included noxious stimulation to the limbs. Apnea testing was mentioned in 71 (91%) protocols; there was variability in the technique and target across protocols. Ancillary testing was included as a requirement for all determinations of BD/DNC in 22 (28%) protocols.
Conclusions:
There is considerable variability in BD/DNC determination protocols around the world. Medical standards for death should be the same everywhere. We recommend that a worldwide consensus be reached on the minimum standards for BD/DNC.
