Controversies in the Determination of Brain Death and Organ Procurement in the Pediatric Population

DOI 47 References
  • Araki Takashi
    Department of Emergency and Critical Care Medicine, Nippon Medical School
  • Yokota Hiroyuki
    Department of Emergency and Critical Care Medicine, Nippon Medical School

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  • 小児の脳死判定と臓器提供における諸問題

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Abstract

  In spite of the fact that it is recognized as an independent pathological phenomenon in neurology, brain death determination has been the subject of considerable controversy from various points of view, especially when related to organ procurement. Particularly, the topic of pediatric brain death has been reviewed with intense interest after the revised Japanese Organ Transplant Act was approved in 2009 because organ procurement from brain-dead children younger than 15 years of age was finally allowed in Japan, an act historically prohibited for decades. On the other hand, in the USA, the consensus based guidelines for the determination of brain death in children, which had been initially published in 1987, were revised in 2011 to include several controversial issues such as sensitivity and specificity of the criteria, effectiveness of the ancillary test for diagnosis, and brain death in neonates. The guidelines of both countries share the fact that clinical neurological findings consisting of deep coma absent of all brain stem reflexes and apnea are fundamental requirements for the diagnosis of brain death. However, since the Japanese law only acknowledges brain death as legal death when the patient has given prior consent to be an organ donor, the diagnosis of brain death requires further precision of judge and a fully sufficient supporting system. The two topics will be discussed herein.<br>  I. Guidelines for the determination of brain death in children.<br>  II. Preparedness for organ procurement from brain-dead children.

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