Brain death in children: a cross-section study enrolling five Brazilian pediatric ICUs

Studies of brain death and organ donation in children are scarce. The objective is to evaluate the incidence of brain death (BD) as well the guidelines and protocols used for confirming BD in five Brazilian PICUs: Porto Alegre, São Paulo and Salvador.

We conducted a cross-sectional and multicenter study based on a retrospective chart review including every death occurring between January 2003 and December 2004 in five Brazilian PICUs of university-affiliated and tertiary hospitals located in Porto Alegre (two), São Paulo (one) and Salvador (two). Two fellows of each service filled a standardized protocol, searching information regarding: demographic aspects, the death cause, the diagnosis of BD and related protocols (or guidelines), and subsequent management. The data were compared using the Student t test, ANOVA, chi-square and RR.

A total of 332 death patients were identified in this period and 37 of them (11.1%) were defined as BD. There was a different rate between the five PICUs (18.2%, 10.1%, 14.7%, 4.8% and 5.0%; P < 0.05). The median age was 50.5 months without statistical difference related to gender. In 81% of the cases the clinical diagnosis of BD was confirmed through cerebral blood flow examinations (ultrasonography/scintigraphy) or EEG. The interval between the diagnosis of BD and the interruption of vital support as well the incidence of withdrawal vital support after the diagnosis BD showed statistical difference (P < 0.01) between the five PICUs. Only six (17.6%) children with BD were organ donors.

Despite Resolution 1.480/97 of the Federal Advice of Medicine published in August 1997 that in a clear and objective way defines the criteria that must be adopted to establish the diagnostic of brain death in Brazil, many services still have tremendous difficulty adopting it. These difficulties were well demonstrated when observing the number of patients that remain with vital support after BD was established and the modest number of organ donors in Brazil.