Abstract
Background and Objective: The amendment to the Japanese Organ Transplant Law in July 2010 has allowed legal determination of brain death and organ donation from brain dead patients in children less than 15 years old. However, there has been only 2 cases of legal brain death in children since then. The actual situation regarding pediatric brain death is not fully understood, and the reason for its paucity has not yet been investigated. Regardless of organ transplant, we have performed general brain death determination prior to the amendment for neurological evaluation. Based on our experience, we have investigated the current situation regarding brain death in children and the reason for its paucity.
Patients: 3,721 children less than 15 years old who admitted to the PICU during a four-year period between July 2008 and June 2012.
Methods: The patients were categorized into pre-amendment or post-amendment depending on the timing of the brain death determination. Characteristics and result of determination were analyzed retrospectively through the medical records.
Results: There were 1,712 patients in the pre-group, and 2,009 patients in the post-group. Brain death evaluation regardless of transplant was performed on 16 cases in the pre-group, and 19 cases in the post-group. Of the patients who were indicated for evaluation, 50% were post-cardiopulmonary resuscitation in the pre-group, and 74% in the post-group, respectively. Admission from emergency room consisted of 94% and 89%, respectively. Only 3 cases in the post-group were evaluated as potential brain death, which consisted 0.1% of total admissions in PICU, and 7% of pediatric death.
Conclusion: The actual situation of pediatric brain death was analyzed in this study. Differences in the criteria for brain death and views on brain death may be contributing factors to its paucity.
All of facilities must be fully prepared for an efficient response in such situation.
