Evaluation of Brain Death in Children in a Tertiary Pediatric Intensive Care Unit

Abstract

Objective: This study aimed to evaluate the characteristics of children who are diagnosed with brain death (BD) in a tertiary care pediatric intensive care unit (PICU) and highlight the organ donation rates. Methods: A retrospective observational study was conducted among pediatric patients who met the criteria of BD based on the medical records in all deaths that occurred between January 2018 and May 2021. The demographic data, main BD cause, duration between admission to PICU and BD decision, length of stay, time between BD decision and cardiac arrest, presence of apnea and ancillary tests, and organ donation status were recorded. Results: This study analyzed 642 patients who are admitted to the PICU, wherein 1.9% was diagnosed as BD. Asphyxia was the most frequent cause of BD (33.3%). The mean interval between the suspected of BD diagnosis and median of duration between BD decision and cardiac arrest were 18.58±13.77 (min: 3, max: 48) h and 36 (minimum (min): 1, maxsimum (max): 192) h, respectively. The mean length of stay in the PICU was 16.75±11.36 days (min: 3, max: 42). The disorders related to BD include diabetes insipidus (58.3%) and hypothermia (33.3%). Apnea test was positive in 6 (50%) of 12 children. At least one ancillary test was used in all patients. Five of 12 (41.7%) patients were not eligible for organ donation because they were refugee, and the families of the remaining 7 patients did not give permission for organ donation. Conclusion: Organ donation can be increased if frequent family meetings are held by an experienced and trained team coordinator, including psychologists and religious authorities. This issue can be organized as a certified and standardized program throughout the country.