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Neurology. 2015 May 5;84(18):1870-9. doi: 10.1212/WNL.0000000000001540. Epub 2015 Apr 8.

Brain death declaration: Practices and perceptions worldwide.

Author information

1
From the Department of Neurology (S.W., F.J.M.), Massachusetts General Hospital, Boston; Department of Neurology (S.W.), Brigham and Women's Hospital, Boston; Harvard Medical School (S.W., F.J.M.), Boston, MA; Division of Neurocritical Care (E.F.M.W.), Mayo Clinic, Rochester, MN; Department of Anesthesiology and Pain Medicine (P.V.P.), Harborview Medical Center, Seattle, WA; Department of Neurology (D.M.G.), Yale University School of Medicine, New Haven, CT; Department of Neurology (J.C.H.), San Francisco General Hospital, CA; and Department of Biostatistics (M.C.), University of Washington, Seattle.
2
From the Department of Neurology (S.W., F.J.M.), Massachusetts General Hospital, Boston; Department of Neurology (S.W.), Brigham and Women's Hospital, Boston; Harvard Medical School (S.W., F.J.M.), Boston, MA; Division of Neurocritical Care (E.F.M.W.), Mayo Clinic, Rochester, MN; Department of Anesthesiology and Pain Medicine (P.V.P.), Harborview Medical Center, Seattle, WA; Department of Neurology (D.M.G.), Yale University School of Medicine, New Haven, CT; Department of Neurology (J.C.H.), San Francisco General Hospital, CA; and Department of Biostatistics (M.C.), University of Washington, Seattle. fmateen@partners.org.

Abstract

OBJECTIVE:

To assess the practices and perceptions of brain death determination worldwide and analyze the extent and nature of variations among countries.

METHODS:

An electronic survey was distributed globally to physicians with expertise in neurocritical care, neurology, or related disciplines who would encounter patients at risk of brain death.

RESULTS:

Most countries (n = 91, response rate 76%) reported a legal provision (n = 63, 70%) and an institutional protocol (n = 70, 77%) for brain death. Institutional protocols were less common in lower-income countries (2/9 of low [22%], 9/18 lower-middle [50%], 22/26 upper-middle [85%], and 37/38 high-income countries [97%], p < 0.001). Countries with an organized transplant network were more likely to have a brain death provision compared with countries without one (53/64 [83%] vs 6/25 [24%], p < 0.001). Among institutions with a formalized brain death protocol, marked variability occurred in requisite examination findings (n = 37, 53% of respondents deviated from the American Academy of Neurology criteria), apnea testing, necessity and type of ancillary testing (most commonly required test: EEG [n = 37, 53%]), time to declaration, number and qualifications of physicians present, and criteria in children (distinct pediatric criteria: n = 38, 56%).

CONCLUSIONS:

Substantial differences in perceptions and practices of brain death exist worldwide. The identification of discrepancies, improvement of gaps in medical education, and formalization of protocols in lower-income countries provide first pragmatic steps to reconciling these variations. Whether a harmonized, uniform standard for brain death worldwide can be achieved remains questionable.

PMID:
25854866
PMCID:
PMC4433464
DOI:
10.1212/WNL.0000000000001540
[Indexed for MEDLINE]
Free PMC Article

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