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Brain Death and Organ Donation in Children

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Fundamentals of Pediatric Neuroanesthesia

Abstract

With the improvement in supportive medical care for critical illnesses, the demand for transplantation organs is increasing worldwide. In the USA, about 112,000 people were waiting for a transplant in 2019, with the total number of transplants done being only 39,718 with 19,267 donors. The organ donation rate in India is one of the lowest globally, with 0.86 per million population compared to the countries like the USA, where the rate is about 31.96 per million population. Although the exact statistics of patients waiting for transplantation are not available in India, the number far exceeds the organs available for transplantation. The live donor transplantation alone cannot match the demand for organs. Hence, the only way to increase the availability of the organs is by retrieving organs from brain-dead patients and cadaveric organ donors.

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References

  1. https://www.organdonor.gov/statistics-stories/statistics.html (accessed online on 0109/2020).

  2. http://organindia.org/make-a-pledge (accessed online on 01/09/2020).

  3. Anon. Guidelines for the determination of death: report of the medical consultants on the diagnosis of death to the President’s commission for the study of ethical problems in medicine and biochemical and behavioral research. JAMA. 1981;246:2184–6.

    Article  Google Scholar 

  4. The Quality Standards Subcommittee of the American Academy of Neurology. Practice parameters for determining brain death in adults (summary statement). Neurology. 1995;45:1012–4.

    Article  Google Scholar 

  5. Wijdicks EF, Varelas PN, Gronseth GS, Greer DM, American Academy of Neurology. Evidence-based guideline update: determining brain death in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2010;74:1911–8.

    Article  PubMed  Google Scholar 

  6. Haupt WF, Rudolf J. European brain death codes: a comparison of national guidelines. J Neurol. 1999;246:432–7.

    Article  CAS  PubMed  Google Scholar 

  7. Wijdicks EF. Brain death worldwide: accepted fact but no global consensus in diagnostic criteria. Neurology. 2002;58:20–5.

    Article  PubMed  Google Scholar 

  8. Greer DM, Wang HH, Robinson JD, Varelas PN, Henderson GV, Wijdicks EF. Variability of brain death policies in the United States. JAMA Neurol. 2016;73:213–8.

    Article  PubMed  Google Scholar 

  9. Wahlster S, Wijdicks EF, Patel PV, Greer DM, Hemphill JC, Carone M, Mateen FJ. Brain death declaration: practices and perceptions worldwide. Neurology. 2015;84:1870–9.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Ad Hoc Committee of the Harvard Medical School. A definition of irreversible coma. Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death. JAMA. 1968;205:337–40.

    Article  Google Scholar 

  11. Green JB, Lauber A. Return of EEG activity after electrocerebral silence: two case reports. J Neurol Neurosurg Psychiatry. 1972;35:103–7.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Collaborative Study. An appraisal of the criteria of cerebral death. A summary statement. A collaborative study. JAMA. 1977;237:982–6.

    Article  Google Scholar 

  13. President’s Commission. Guidelines for the determination of death. Report of the medical consultants on the diagnosis of death to the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. JAMA. 1981;246:2184–6.

    Article  Google Scholar 

  14. Guidelines for the Determination of Brain Death in Children. Task Force for the determination of brain death in children. Neurology. 1987, 37:1077–8.

    Google Scholar 

  15. Kaufman HH, Geisler FH, Kopitnik T, Higgins W, Stewart D. Detection of brain death in barbiturate coma: the dilemma of an intracranial pulse. Neurosurgery. 1989;25:275–7. discussion 277-8

    Article  CAS  PubMed  Google Scholar 

  16. Banasiak KJ, Lister G. Brain death in children. Curr Opin Pediatr. 2003;15(3):288–93.

    Article  PubMed  Google Scholar 

  17. Freeman JM, Ferry PC. New brain death guidelines in children: further confusion. Pediatrics. 1988;81:301–3.

    CAS  PubMed  Google Scholar 

  18. Shewmon DA. Commentary on guidelines for the determination of brain death in children. Ann Neurol. 1988;24:789–91.

    Article  CAS  PubMed  Google Scholar 

  19. Nakagawa TA, Ashwal S, Mathur M, Mysore MR, Bruce D, Conway EE Jr, et al. Society of Critical Care Medicine; Section on Critical Care and Section on Neurology of the American Academy of Pediatrics; Child Neurology Society. Guidelines for the determination of brain death in infants and children: an update of the 1987 Task Force recommendations. Crit Care Med. 2011;39:2139–55.

    Article  PubMed  Google Scholar 

  20. National Conference of Commissioners on Uniform State Laws. 1981. The Uniform Determination of Death Act 1981.

    Google Scholar 

  21. Seifi A, Lacci JV, Godoy DA. Incidence of brain death in the United States. Clin Neurol Neurosurg. 2020;195:105885. https://doi.org/10.1016/j.clineuro.2020.105885. Epub ahead of print

    Article  PubMed  Google Scholar 

  22. Greer DM, Shemie SD, Lewis A, et al. Determination of brain death/death by neurologic criteria: The World Brain Death Project. JAMA. 2020;324(11):1078–97. https://doi.org/10.1001/jama.2020.11586.

    Article  PubMed  Google Scholar 

  23. Ashwal S. Brain death in the newborn. Current perspectives. Clin Perinatol. 1997;24:859–82.

    Article  CAS  PubMed  Google Scholar 

  24. Parker BL, Frewen TC, Levin SD, et al. Declaring pediatric brain death: Current practice in a Canadian pediatric critical care unit. CMAJ. 1995;153:909–16.

    CAS  PubMed  PubMed Central  Google Scholar 

  25. Government of India. Transplantation of Human Organs Act, 1994. 1994. Central Act 42 of [cited 2007 Mar 9]. Available from: http://www.medindianet/tho/thobill1asp.

  26. Schneider S. Usefulness of EEG in the evaluation of brain death in children: the cons. Electroencephalogr Clin Neurophysiol. 1989;73:276–8.

    Article  CAS  PubMed  Google Scholar 

  27. Conrad GR, Sinha P. Scintigraphy as a confirmatory test of brain death. Semin Nucl Med. 2003;33:312–23.

    Article  PubMed  Google Scholar 

  28. Abdel-Dayem HM, Bahar RH, Sigurdsson GH, Sadek S, Olivecrona H, Ali AM. The hollow skull: a sign of brain death in Tc-99m HM-PAO brain scintigraphy. Clin Nucl Med. 1989;14:912–6.

    Article  CAS  PubMed  Google Scholar 

  29. Bonetti MG, Ciritella P, Valle G, Perrone E. 99mTc HM-PAO brain perfusion SPECT in brain death. Neuroradiology. 1995;37:365–9.

    CAS  PubMed  Google Scholar 

  30. Valle G, Ciritella P, Bonetti MG, Dicembrino F, Perrone E, Perna GP. Considerations of brain death on a SPECT cerebral perfusion study. Clin Nucl Med. 1993;18:953–4.

    Article  CAS  PubMed  Google Scholar 

  31. Wilson K, Gordon L, Selby JB Sr. The diagnosis of brain death with Tc-99m HMPAO. Clin Nucl Med. 1993;18:428–34.

    Article  CAS  PubMed  Google Scholar 

  32. Drake B, Ashwal S, Schneider S. Determination of cerebral death in the pediatric intensive care unit. Pediatrics. 1986;78:107–12.

    CAS  PubMed  Google Scholar 

  33. Ashwal S, Schneider S, Thompson J. Xenon computed tomography measuring cerebral blood flow in the determination of brain death in children. Ann Neurol. 1989;25:539–46.

    Article  CAS  PubMed  Google Scholar 

  34. Parker BL, Frewen TC, Levin SD, Ramsay DA, Young GB, Reid RH, Singh NC, Gillett JM. Declaring pediatric brain death: current practice in a Canadian pediatric critical care unit. CMAJ. 1995;153:909–16.

    CAS  PubMed  PubMed Central  Google Scholar 

  35. Berenguer CM, Davis FE, Howington JU. Brain death confirmation: comparison of computed tomographic angiography with nuclear medicine perfusion scan. J Trauma. 2010;68:553–9.

    PubMed  Google Scholar 

  36. Escudero D, Otero J, Marqués L, Parra D, Gonzalo JA, Albaiceta GM, Cofiño L, Blanco A, Vega P, Murias E, Meilan A, Roger RL, Taboada F. Diagnosing brain death by CT perfusion and multislice CT angiography. Neurocrit Care. 2009;11:261–71.

    Article  PubMed  Google Scholar 

  37. Ishii K, Onuma T, Kinoshita T, Shiina G, Kameyama M, Shimosegawa Y. Brain death: MR and MR angiography. AJNR Am J Neuroradiol. 1996;17:731–5.

    CAS  PubMed  PubMed Central  Google Scholar 

  38. Chiu NC, Shen EY, Ho CS. Outcome in children with significantly abnormal cerebral blood flow detected by Doppler ultrasonography: focus on the survivors. J Neuroimaging. 2003;13:53–6.

    Article  PubMed  Google Scholar 

  39. Dosemeci L, Dora B, Yilmaz M, Cengiz M, Balkan S, Ramazanoglu A. Utility of transcranial Doppler ultrasonography for confirmatory diagnosis of brain death: two sides of the coin. Transplantation. 2004;77:71–5.

    Article  PubMed  Google Scholar 

  40. de Freitas GR, Andre C. Routine insonation of the transorbital window for confirming brain death: a double-edged sword. Arch Neurol. 2003;60:1169.

    Article  PubMed  Google Scholar 

  41. Meyer MA. Evaluating brain death with positron emission tomography: case report on dynamic imaging of 18F-fluorodeoxyglucose activity after intravenous bolus injection. J Neuroimaging. 1996;6:117–9.

    Article  CAS  PubMed  Google Scholar 

  42. Rosendale JD, Chabalewski FL, McBride MA, et al. Increased transplanted organs from the use of a standardized donor management protocol. Am J Transplant. 2002;2:761–8.

    Article  PubMed  Google Scholar 

  43. Rosendale JD, Kauffman HM, McBride MA, et al. Aggressive pharmacologic donor management results in more transplanted organs. Transplantation. 2003;75:482–7.

    Article  PubMed  Google Scholar 

  44. Franklin GA, Santos AP, Smith JW, Galbraith S, Harbrecht BG, Garrison RN. Optimization of donor management goals yields increased organ use. Am Surg. 2010;76:587–94.

    Article  PubMed  Google Scholar 

  45. Nakagawa TA. Updated pediatric donor management and dosing guidelines. NATCO, The Organization for Transplant Professionals, 2008. Available at: http://www.organdonationalliance.org/wpcontent/uploads/toolbox/NATCOPedDonorManagementGuidelines-odt.pdf

  46. Scheinkestel CD, Tuxen DV, Cooper DJ, Butt W. Medical management of the (potential) organ donor. Anaesth Intensive Care. 1995;23:51–9.

    Article  CAS  PubMed  Google Scholar 

  47. Cittanova ML, Leblanc I, Legendre C, et al. Effect of hydroxyethylstarch in brain-dead kidney donors on renal function in kidney-transplant recipients. Lancet. 1996;348:1620–2.

    Article  CAS  PubMed  Google Scholar 

  48. Blasco V, Leone M, Antonini F, et al. Comparison of the novel hydroxyethyl starch 130/0.4 and hydroxyethyl starch 200/0.6 in braindead donor resuscitation on renal function after transplantation. Br J Anaesth. 2008;100:504–8.

    Article  CAS  PubMed  Google Scholar 

  49. Pennefather S, Bullock RE, Dark JH. The effect of fluid therapy on alveolar arterial oxygen gradient in brain-dead organ donors. Transplantation. 1993;56:1418–22.

    Article  CAS  PubMed  Google Scholar 

  50. Tuttle-Newhall JE, Collins BH, Kuo PC, Schroeder R. Organ donation and treatment of multi-organ donor. Curr Probl Surg. 2003;40:266–310.

    Article  PubMed  Google Scholar 

  51. Shemie SD, Ross H, Pagliarello J, et al. Organ donor management in Canada: recommendations of the forum on Medical Management to Optimize Donor Organ Potential. CMAJ. 2006;174:S13–32. https://doi.org/10.1503/cmaj.045131.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Zuppa AF, Nadkarni V, Davis L, et al. The effect of a thyroid hormone infusion on vasopressor support in critically ill children with cessation of neurologic function. Crit Care Med. 2004;32:2318–22.

    Article  CAS  PubMed  Google Scholar 

  53. Orlowski JP. Evidence that thyroxine (T-4) is effective as a hemodynamic rescue agent in management of organ donors. Transplantation. 1993;55:959–60.

    Article  CAS  PubMed  Google Scholar 

  54. Iwai A, Sakano T, Uenishi M, Sugimoto H, Yoshioka T, Sugimoto T. Effects of vasopressin and catecholamines on the maintenance of circulatory stability in brain-dead patients. Transplantation. 1989;48:613–7.

    CAS  PubMed  Google Scholar 

  55. Abdelnour T, Rieke S. Relationship of hormonal resuscitation therapy and central venous pressure on increasing organs for transplant. J Heart Lung Transplant. 2009;28:480–5.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Neuroanaesthesiology, Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India

    Prasanna Udupi Bidkar & Srinivasan Swaminathan

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  1. Prasanna Udupi Bidkar
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  2. Srinivasan Swaminathan
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  1. Department of Neuroanesthesiology & Critical Care, All India Institute of Medical Sciences, New Delhi, Delhi, India

    Girija Prasad Rath

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Bidkar, P.U., Swaminathan, S. (2021). Brain Death and Organ Donation in Children. In: Rath, G.P. (eds) Fundamentals of Pediatric Neuroanesthesia. Springer, Singapore. https://doi.org/10.1007/978-981-16-3376-8_40

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  • DOI: https://doi.org/10.1007/978-981-16-3376-8_40

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