Pediatric brain stem death: Perspectives for the future in India

Abstract

Pediatric brain stem death needs to be recognized both for futility in resuscitative efforts and in scope for organ donation. Pediatric donation can be performed from 37 weeks gestational age to 18 years. The diagnosis of brain stem death is completed by two clinical examinations separated by an interval of 24 h in term newborns and neonates and 12-h interval infants and children. Apnea testing is the main diagnostic test supported by tests of cranial nerve functions. Ancillary tests have not been approved for the diagnosis of brain stem death in India. Donor management is critical and needs invasive lines and attention to the maintenance of hemodynamics, fluid management, temperature, and hormonal resuscitation.Shifting the goals of care to organ maintenance can be challenging for the medical team. Counseling for donation needs to be sympathetic and honest while letting the parents understand that return back to life is impossible. Religious, cultural, and social customs of the family need to be respected and supported and the medical social worker is the key person in the establishment of a rapport with the grieving family. Creation of awareness among public and health-care professionals beside the involvement of governmental organizations both to endorse the process and support costs toward the program at least in its developmental phase is needed for this program in India.