Guidelines for the Determination of Brain Death in Children

Abstract

Most states now have laws on brain death, and the American Medical Association, the American Bar Association, the National Conference of Commissioners on Uniform State Laws, the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, and this Task Force have all endorsed the following language regarding the determination of death: An individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions or (2) irreversible cessation of all functions of the entire brain, including the brainstem, is dead. A determination of death must be made in accordance with accepted medical standards. There are no unique legal issues in determining brain death in children as compared with adults. The unique issues are all medical ones and related directly to the more difficult tasks of confirming brain death in young children. Current criteria of brain death avoid application of these standards to "young children." The report of the presidential commission1 outlines criteria valid in children older than 5 years of age. It is generally assumed that the child's brain is more resistant to insults leading to death, although this issue is controversial and lacks convincing clinical documentation.2,3 The criteria outlined are useful in determining brain death in infants and children. In term newborns (> 38 weeks' gestation), the criteria are useful seven days after the neurologic insult. The newborn is difficult to evaluate clinically after perinatal insults. This relates to many factors including difficulties of clinical assessment, determination of proximate cause of coma, and certainty of the validity of laboratory tests.