Variability across countries for brain death determination in adults

Abstract

Background: Currently there is variability in diagnostic procedures across countries. Our aim was to compare guidelines of brain death determination in adults among ve countries: China, UK, US, France, and Germany.Method: This is a retrospective study based on a prospective database of consecutive coma patients who received brain death determination. The technical speci cations, completion rates, and positive rates of brain death determination according to criteria of different countries were compared. The accuracy, sensitivity, speci city, positive predictive value (PPV), and negative predictive value (NPV) of each ancillary test for the identi cation of brain death diagnosed according to different criteria were investigated.Results: One hundred and ninety-nine patients who received brain death determination from June 2018 to June 2020 were included in this study. One hundred and thirty-one (65.8%) patients were diagnosed with brain death according to French criteria, 132 (66.3%) according to Chinese criteria, and 135 (67.7%) according to criteria of US, UK, and Germany. The sensitivity and PPV of EEG (92.2% -92.3%) and SLSEP (95.5% -98.5%) were higher than TCD (84.3% -86.0%), and all these three tests have a very low speci city and NPV.Conclusions: The duration of apnea test and requirements of ancillary tests vary among countries. The discrepancy in brain death determination between clinical assessments and additional con rmation of ancillary tests is small. BackgroundThe concept of death has been a philosophical debate as well as a medical controversy for millennia. The rapid development of technology in life support continues to blur the line between life and death. A major confusion among the public is the difference between death of the person and death of the human organs. In 1968, the Harvard Ad Hoc Committee proposed that death of the individual could be determined as the cessation of brain function (irreversible coma), despite the persistent respiration and circulation supported by mechanical ventilation 1 . This visionary widely accepted concept opened up the avenue for exploring criteria and tools for brain death determination.Most countries have implemented laws giving a legal de nition of brain death, however, the legalization of brain death is still on the way in China 2 . Medical consensuses have been reached across countries that the determination of brain death is to diagnose the irreversible cessation of the entire brain function by con rming the absence of consciousness due to a known cause, brainstem re exes, and spontaneous breath. Only in the United Kingdom, brain death was de ned as the irreversible cessation of brain-stem function 3,4 . On the operational level, there are still a few disparities in the diagnostic procedures across countries. In this study, we compared national guidelines of brain death in adults among ve countries with different criteria: China, United Kingdom (UK), United States (US), France, and Germany. Methods Study designThis retrospective study was based on a prosp...