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Brain death in early infancy
1Division of Pediatric Neurology, Loma Linda University Medical Center, CA 92354.
Insights
Pediatric brain death determination follows established guidelines, ensuring accurate organ donation. Studies confirm adherence to criteria, supporting timely heart and other organ transplants in children.
Area of Science:
- Pediatric critical care medicine
- Neurology
- Organ transplantation
Background:
- Established guidelines exist for diagnosing brain death in pediatric patients.
- Diagnosis requires coma, absent cranial nerve reflexes, and apnea.
- Neurodiagnostic studies are recommended for children under one year.
Purpose of the Study:
- To evaluate adherence to brain death diagnostic criteria in pediatric organ donors.
- To assess the accuracy and timeliness of brain death determination and organ procurement.
- To identify potential improvements in the pediatric organ donation process.
Main Methods:
- Retrospective review of 52 pediatric heart donor patient records.
- Analysis of clinical documentation for coma, reflexes, and apnea.
- Review of neurodiagnostic studies: electroencephalograms (EEGs) and cerebral blood flow (CBF) studies.
- Examination of apnea challenge test results.
Main Results:
- All 52 patients met clinical criteria for brain death, confirmed by two physicians.
- Apnea challenge tests were performed in 27 patients (mean PCO2 73.3 torr).
- Electroencephalograms showed electrocerebral silence in 28/33 studies; cerebral blood flow studies indicated absent flow in 19/22.
- Successful transplantation of hearts (52), livers (34), kidneys (15), and other organs.
Conclusions:
- Current criteria and procedures for determining brain death in pediatric organ donors are effectively utilized.
- Accurate and timely diagnosis facilitates successful organ procurement for transplantation.
- Recommending apnea challenge tests in all eligible patients could enhance donor yield.
Abstract:
Guidelines for the determination of brain death in infants and children are now well established. Coma, absence of cranial nerve reflexes, and apnea are required in all patients. In children less than 1 year of age, supportive neurodiagnostic studies (electroencephalograms and cerebral blood flow) are recommended. Data on 52 pediatric heart donor patients were reviewed to assess whether current criteria and procedures were used in the determination of brain death. The mean age of the donors (14.3 months) was higher than that of the recipients (2.6 months). In all patients the hospital records documented coma, fixed dilated pupils, absent brain stem reflexes, apnea, and verification of the diagnosis of brain death by two physicians who were not part of the transplantation team. In 27 of 52 patients, apnea challenge tests were performed; the mean PCO2 was 73.3 torr. Thirty-three of 52 patients had electroencephalograms performed; electrocerebral silence was found in 28 of 33 studies. Twenty-two of 52 patients had cerebral blood flow studies; in 19 of 22 studies the absence of flow was observed. Of the 52 patients the following number of organs were transplanted: heart (52), liver (34), kidneys (15), corneas (6), lung (4), and pancreas (2). These data indicate that the diagnosis of brain death is being made accurately and in a timely manner as is the harvesting of organs. Improvements could be made by requiring, if possible, the performance of an apnea challenge test in all patients. The data also suggest the potential to increase the donor yield.