Determination of brain death in children--a medicial center experience.

We retrospectively reviewed our organ donation team's database (timeframe: 1988-2003) identifying 18 patients under 18 years old meeting criteria for the diagnosis of brain death. We emphasized the primary diagnosis, observation period, physical findings, neurological findings, and the apnea test results according to the 1987 guidelines for brain death determination. The average age at diagnosis was 13 years and 8 months old (range: 3 months-18 years; median: 16 years). Fifteen children (82%) suffered head injuries; one (6%) had hypoxic ischemic encephalopathy; one (6%) suffered intracranial hemorrhage; and one (6%) had a brain tumor. The average observation period from clinical suspicion of brain death to the brain death test was 146 hours (range: 16-1416 hours; median: 72 hours). Among the 18 patients fulfilling the criteria, brain death was declared after two successful apnea tests performed at least 4 hours apart (average: 6 hours; range: 4-18 hours). Solid organ procurement was successful in all patients (100%). Use of the guidelines for determining brain death in children is limited in Taiwan; however, we found that the previously used guidelines in Taiwan might be appropriate for children above 3 years old, although further study is necessary to determine the roles of electroencephalography and cerebral blood flow measurement in younger children.