Pediatric brain death in a Japanese pediatric hospital.

Aim: The Organ Transplantation Act was revised in Japan in 2010, which permitted the organs of children younger than 15 years to be donated after brain death. As of August 2012, 2 years after the Act was revised, only two children had become brain dead donors.In our hospital, we used a basic determination of brain death in order to predict the neurological outcome. We evaluated the incidence and characteristics of pediatric brain death treated at our hospital in order to investigate why there are so few pediatric brain deaths in Japan.
Methods: We evaluated the characteristics of patients undergoing a basic determination of brain death and the procedure for the determination was compared retrospectively by reviewing their medical records. We enrolled 3,721 patients aged younger than 15 years who were admitted to the pediatric intensive care unit between 2008 and 2012.
Results: A basic determination of brain death had been enacted in 35 patients. Many of the patients undergoing the determination were admitted after resuscitation (pre-group / post-group, 50%/74%) and many of them had been transferred from the emergency department (94%/89%). After revision of the Act, only three children were deemed to be brain dead in our hospital, which was 0.1% of total pediatric intensive care unit admissions and 7% of total pediatric intensive care unit deaths. Conclusions: The low incidence of pediatric brain death in Japan may be due to differences in exclusion criteria for determination of brain death and personal views regarding life and death compared with other countries.