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Ancillary Testing for Determination of Death by Neurologic Criteria Around the World

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Abstract

Objective

We sought to identify similarities and differences in the diagnostic requirements for ancillary testing for determination of brain death/death by neurologic criteria (BD/DNC) around the world.

Methods

We reviewed diagnostic requirements for ancillary testing for BD/DNC in 78 unique official national BD/DNC protocols obtained from contacts worldwide between January 2018 and April 2019.

Results

Details provided on the performance and interpretation of ancillary tests for determination of BD/DNC were variably provided and inconsistent. Approximately half of all protocols that included each ancillary test provided details about study performance: 63% of protocols that included conventional cerebral angiography, 55% of protocols that included electroencephalography, 50% of protocols that included somatosensory evoked potentials, 48% of protocols that included transcranial Doppler ultrasonography, 43% of protocols that included nuclear medicine flow study and 41% of protocols that included brainstem auditory evoked potentials. Similarly, about half of all protocols that included each ancillary test provided details about study interpretation: 66% of protocols that included electroencephalography, 59% of protocols that included brainstem auditory evoked potentials, 56% of protocols that included somatosensory evoked potentials, 55% of protocols that included transcranial Doppler ultrasonography, 52% of protocols that included conventional cerebral angiography and 49% of protocols that included nuclear medicine flow study.

Interpretation

Diagnostic requirements for ancillary testing in BD/DNC determination vary around the world. We hope that the World Brain Death Project will improve worldwide consensus on the diagnostic requirements for ancillary testing in BD/DNC, both for performance and interpretation.

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Data

Ariane Lewis takes responsibility for the data and accuracy of data analysis.

References

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Acknowledgments

The authors would like to thank the following individuals for their assistance obtaining protocols for this project: Abualia, Mohammad (Jordan), Abulhasan, Yasser (Kuwait), Abente, Silvia (Paraguay), Agerlin, Niels (Denmark), Akhtar, Naveed (Qatar), Alarcon Aviles, Tomas (Ecuador), Anamnart, Chumpol (Thailand), Arab, Ouail (Algeria), Araqi Houssaini, Adil (Morocco), Arguello Lopez, Becket (Nicaragua), Armendariz Landois, Paulina (Mexico), Ashayeriahmadabad, Rezan (Iran), Attar, Besher (Saudi Arabia), Badenes, Rafael (Spain), Beca, John (New Zealand), Berlot, Rok (Slovenia), Bohatyrewicz, Romuald (Poland), Boldbaatar, Khatantuul (Mongolia), Bulic, Sebina (Bosnia and Herzegovina), Busic, Mirela (Croatia), Castillo Abrego, Guadalupe (Honduras, Panama), Chan, Louisa (Malaysia), Charpentier, Julien (France), Chumbe Mendoza, Maria Mercedes (Peru), Cohen, Jonathan (Israel), Cornejo, Francisco (El Salvador), Cronberg, Tobias (Denmark, Sweden), Demeritte, Edwin (Bahamas), Do, Son (Vietnam), Duska, Frantisek (Czech Republic, Ireland, Slovakia), Eismant, Aleksandr (Belarus), Erakovic, Jevto (Montenegro), Faruq, Mohammad Omar (Bangladesh), Getova, Radostina (Bulgaria), Gogovska, Lodi (Macedonia), Gradisek, Primoz (Slovenia), Groysman, Leonid (Romania), Hadjigeorgiou, Georgios (Cyprus), Hoppe, Arnold (Chile), Jowi, James (Kenya), Keller, Emanuela (Switzerland), Khoury, Samia (Lebanon), Kirkegaard, Hans (Denmark), Kirste, Gunter (Germany), Ko, Sang-Bae (South Korea), Kobata, Hitoshi (Japan), Kornips, Bert (Netherlands), Kõrv, Janika (Estonia), Kuroda, Yasuhiro (Japan), Lisnic, Vitalie (Moldova), Lucic-Samardzija, Vesna (Bosnia and Herzegovina), Lukic, Stevo (Serbia), Lundeg, Ganbold (Mongolia), Machado, Calixto (Cuba), Mallia, Pierre (Malta), Mallick, Uzzwal Kumar (Bangladesh), Manara, Alex (UK), Mariano, Geraldine (Philippines), Marquevich, Victoria (Argentina), Maryenko, Lidiya (Ukraine), Mejia, Jorge (Colombia), Milivojevic, Natasa (Slovenia), Mora, Jacobo (Venezuela), Moreno, Rui (Portugal), Mouhaoui, Mohammed (Morocco), Opdam, Helen (Australia), Palazis, Lakis (Cyprus), Panday, Avidesh (Trinidad and Tobago), Piva, Jefferson (Brazil), Puppo, Corina (Uruguay), Rhassane, Ahmed (Morocco), Saelim, Kantara (Thailand), Sandroni, Caludio (Italy), Schmutzhard, Erich (Austria), Scrifvars, Marcus (Finland), Shrestha, Gentle (Nepal), Silesky, Juan (Costa Rica), Sinkin, Mikhail (Kazakhstan, Russia), Sorensen, Dag Wendelbo (Norway), Swiat, Maciej (Poland), Tchantchaleishvili, Nana (Georgia), Thorkelsson, Thordur (Iceland), Tsertsvadze, Iakob (Georgia), Tong Kiat, Kwek (Singapore), Topcuoglu, Mehmet Akif (Turkey), Tsivgoulis, Georgios (Cyprus), Varelas, Panayiotis (Greece), Wang, Yuyang (China), Westphal, Glauco (Brazil), Yu-Chang Yeh, Tony (Taiwan), Zairinal, Ramdinal Aviesena (Indonesia), Zirpe, Kapil (India).

Funding

No authors received financial compensation for this study.

Author information

Authors and Affiliations

  1. Division of Neurocritical Care, Departments of Neurology and Neurosurgery, NYU Langone Medical Center, 530 First Avenue, HCC-5A, New York, NY, 10016, USA

    Ariane Lewis

  2. NYU School of Medicine, 530 First Avenue, New York, NY, USA

    Jordan Liebman, Elana Kreiger-Benson, Andrew Kumpfbeck & Azza Bakkar

  3. Montreal Children’s Hospital, McGill University, 1001 Decarie Blvd, Montreal, Canada

    Sam D. Shemie

  4. Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, Canada

    Sam D. Shemie & Sylvia Torrance

  5. LAC and USC Medical Center, 2051 Marengo Street, Los Angeles, USA

    Gene Sung

  6. Boston University School of Medicine, 72 East Concord Street, Collamore 3, Suite 338, Boston, USA

    David Greer

Authors
  1. Ariane Lewis
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  2. Jordan Liebman
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  3. Elana Kreiger-Benson
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  4. Andrew Kumpfbeck
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  5. Azza Bakkar
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  6. Sam D. Shemie
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  7. Gene Sung
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  8. Sylvia Torrance
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  9. David Greer
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Contributions

AL was responsible for conception and design, data collection, analysis and interpretation of data, drafting the manuscript, statistical analysis and final approval of the manuscript. AB, EK-B, AK and JL are responsible for analysis and interpretation of data, critical revision of the manuscript and final approval of the manuscript. SDS, GS, ST and DG are responsible for conception and design, data collection, critical revision of the manuscript and final approval of the manuscript.

Corresponding author

Correspondence to Ariane Lewis.

Ethics declarations

Conflict of interest

Although five of the authors of this paper comprise the Steering Committee of the World Brain Death Project, this paper is not part of the World Brain Death Project. Ariane Lewis is a Deputy Editor for the Disputes and Debates Section of Neurology and was a guest editor for Neurosurgical Focus and Seminars in Neurology. Sam D. Shemie is Medical Advisor to Canadian Blood Services Deceased Organ Donation and an Associate Investigator at MUHC Research Institute. David Greer is the Editor in Chief for Seminars in Neurology and receives research support from Becton Dickenson and an NIH R01.

Ethical Approval

IRB review of this study was waived due to absence of human subjects.

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Lewis, A., Liebman, J., Kreiger-Benson, E. et al. Ancillary Testing for Determination of Death by Neurologic Criteria Around the World. Neurocrit Care 34, 473–484 (2021). https://doi.org/10.1007/s12028-020-01039-6

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  • DOI: https://doi.org/10.1007/s12028-020-01039-6

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