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Variability in Pediatric Brain Death Determination Protocols in the United States
Conall Francoeur1, Matthew J Weiss1, Jennifer M MacDonald1
1From Université Laval Research Center (C.F., M.J.W.), CHU de Québec Université Laval, Canada; Division of Pediatric Critical Care Medicine (J.M.M.), Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus; Department of Pediatrics (C.P.), Section of Neurology, University of Colorado, Denver; Department of Neurology (D.M.G.), Boston University, MA; and Departments of Anesthesiology and Critical Care Medicine (R.A.B., A.A.T., W.M., M.P.K.), Pediatrics (R.A.B., A.A.T., W.M., M.P.K.), and Neurology (M.P.K.), Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania.
Pediatric death by neurologic criteria (DNC) protocols show significant variability between institutions, particularly in apnea and ancillary testing. Greater adherence to national guidelines can enhance consistency and accuracy in DNC determination.
Area of Science:
- Neurology
- Pediatric critical care
- Organ donation
Background:
- Determining death by neurologic criteria (DNC) is crucial for organ donation.
- Standardized DNC protocols are essential for consistent application of neurologic criteria.
Purpose of the Study:
- To assess the variability in pediatric death by neurologic criteria (DNC) protocols across US institutions.
- To compare current pediatric DNC protocols with the 2011 DNC guidelines.
Main Methods:
- A cross-sectional study analyzed 130 pediatric DNC protocols from US institutions.
- Protocols were evaluated across five domains: general procedures, prerequisites, neurologic examination, apnea testing, and ancillary testing.
- Descriptive statistics were used to compare protocols and the 2011 DNC guidelines.
Main Results:
- Most protocols (97%) required identification of irreversible brain injury, and 67% mandated an observation period.
- Prerequisites like exclusion of hypotension (94%), hypothermia (97%), and metabolic derangements (92%) were commonly met.
- Significant variability was observed in apnea testing (84% used 2 tests) and ancillary testing (15% required unvalidated studies).
Conclusions:
- Pediatric DNC protocols exhibit considerable variability in all assessed domains, notably in apnea and ancillary testing.
- Improved alignment of institutional protocols with national DNC guidelines is recommended to enhance consistency and accuracy.
