A review of current controversies in determining death by neurologic criteria in children. Issue 6 (December 2020)

• Record Type: Journal Article
• Authors: Virupakshaiah, Akash; Ichord, Rebecca; Topjian, Alexis A.; Kirschen, Matthew P.
• Is Part Of: Current opinion in pediatrics. Volume 32:Issue 6(2020:Dec.)
• Publication Date: 2020-12
• Subjects: ancillary testing -- apnea testing -- brain death -- death by neurologic criteria; Pediatrics -- Periodicals; Pediatrics -- Periodicals -- Bibliography -- Periodicals; 618.92
• DOI: 10.1097/MOP.0000000000000952
• Languages: English
• ISSNs: 1040-8703

Abstract

Abstract : Purpose of review: Death by neurologic criteria (DNC) is the irreversible cessation of all functions of the entire brain, including the brainstem. It is legally recognized as equivalent to cardiopulmonary death. Legal and ethical controversies surrounding DNC have emerged as a result of several highly publicized cases that have eroded public trust in our ability to declare DNC accurately. In this review, we focus on recently published primary data about DNC and address some of these controversies. Recent findings: Approximately 21% of children who die in pediatric intensive care units (PICU) are declared DNC. Although 60% of physicians report that they have been asked to maintain organ support after DNC declaration, less than 1% of patients remain physically present in the PICU more than 5 days after DNC declaration. We discuss strategies for safely conducting the apnea test, indications and prevalence of ancillary testing, and objections to DNC, including issues of consent and requests for ongoing organ support. Summary: In order to maintain public trust, published guidelines must be followed to accurately and consistently diagnose DNC. We must develop strategies to respond to objections to DNC determination. Ongoing research is needed to improve the safety of apnea testing and indications for and interpretation of ancillary testing.