Variability across countries for brain death determination in adults

ABSTRACT

Background

The guidelines of brain death determination vary across countries. Our aim was to compare diagnostic procedures of brain death determination in adults among five countries.

Method

Consecutive comatose patients who received brain death determination from June 2018 to June 2020 were included. The technical specifications, completion rates and positive rates of brain death determination according to criteria of different countries were compared. The accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of each ancillary test for the identification of brain death diagnosed according to different criteria were investigated.

Results

One hundred and ninety nine patients 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 USA, UK and Germany. The sensitivity and PPV of electroencephalogram (92.2% – 92.3%) and somatosensory evoked potential (95.5% – 98.5%) were higher than transcranial Doppler (84.3% – 86.0%).

Conclusions

The criteria of brain death in China and France are comparatively stricter than in USA, UK and Germany. The discrepancy in brain death determination between clinical assessments and additional confirmation of ancillary tests is small.

KEYWORDS:

• Brain death
• consciousness
• coma
• electroencephalogram
• somatosensory-evoked potentials
• transcranial Doppler

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

Study concept and design: FY, LW, SW; data acquisition: HL, TP, WW; analysis and interpretation of data: LH, TP, WW; drafting of the manuscript: FY and SW; study supervision: LW, SW; critical revision: FY, LW, SW. All authors read and approved the final manuscript.

Ethical statements

The study was approved by the Ethics Committee of The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (ZE2020-217-01). All the procedures in brain death determination were based on the Chinese guidelines, the informed consent was waived therefore. All the data in this study have been de-identified. This study was conducted in compliance with Chinese laws and the Declaration of Helsinki.

Data availability statement

By request to the corresponding author.

Additional information

Funding

This study was funded by “Double-First Class” and Innovative Teams Project of Guangdong University of Chinese Medicine [2021xk26];