Variations in Brain Death Declaration: A Worldwide Survey (P4.298)

OBJECTIVE: To investigate the practice of brain death declaration on an international level. BACKGROUND: The concept of brain death has evolved since first delineated in the 1960s. In 1995 the AAN published evidence-based practice parameters, most recently updated in 2010, to provide an algorithmic, universal step-by-step approach to brain death determination. DESIGN/METHODS: An electronic survey was distributed to physicians with reputed knowledge of brain death via the Neurocritical Care Society, published correspondence addresses, and personal contacts. RESULTS: The response rate was 71.5% (88 of 123 countries contacted); 28% of respondents (n=25) were from low- and middle-income countries (LMICs). Respondents were neurointensivists (n=17, 19%), non-neurologist intensivists (n=19, 22%), neurologists (n=42, 48%) and physicians from other relevant subspecialties (n=10, 12%).Most countries (77%, n=68) reported the presence of a formal institutional protocol. Among those hospitals without a provision for brain death, 80% (n=15) were from LMICs; the most common reasons cited for the absence of brain death declaration were ‘no advanced technology/ICU care’ (n=15, 77%) and ‘no physician expertise’ (n=12, 62%). Countries with an organized transplant network were more likely to have a brain death provision compared with countries without (54/62, 87% vs. 6/24, 25%, p<0.001). Marked variability was noted in requisite examination findings, execution of apnea testing, necessity and type of ancillary testing, as well as the number and minimum qualifications of physicians required for declaration. Distinct criteria for declaration in children were common (56%, n=38). CONCLUSIONS: This recent worldwide survey demonstrates that the concept of brain death is widely established, but marked differences remain in the practice of declaration, even amongst neurological specialists. We expand on the previous reports by adding 26 countries and exploring additional parameters. These differences may be due to cultural, religious and legal reasons, personal concepts of brain death or a combination of these influences. Disclosure: Dr. Wahlster has nothing to disclose. Dr. Wijdicks has received personal compensation in an editorial capacity for Neurocritical Care. Dr. Patel has nothing to disclose. Dr. Greer has nothing to disclose. Dr. Hemphill has received personal compensation for activities with Ornim as an advisory board member, and in medicolegal matters. Dr. Hemphill has received research support from Cerebrotech Medical. Dr. Mateen has nothing to disclose.