Pediatric Brain Death and Organ/Tissue Retrieval

The death Of a child One whOse vulnerability and unfilled promise cOmpOunds the tragedy Of any death tOuches us deeply. When that death Occurs due tO the generally unexpected and sudden loss Of brain functiOn it is particularly POignant. And yet when death cOmes it shOuld be diag­ nosed expeditiOusly. The professiOnal resPOnsibilities Of the physician require that he bOth rec­ Ognize brain death and infOrm the family Of its occurrence. In additiOn since recent advances in transplantatiOn provide the POssibility Of using the Organs Of a brain-dead child tO save the lives Of Other children the cOncepts Of beneficence an~ charity further cOmpel physicians tO facilitate such transplantatiOns by infOrming the family about this POssibility. Criteria Of brain death have been refined Over about 30 years since the term coma depasse (beyOnd cOma) was coined by MOllaret and GOulon in 1957 (Kaufman and Lynn 1986). The last majOr criteria evOlved On a natiOnal level were thOse Of the Presidents COmmissiOn in 1981. HOwever studies tO date have cOncentrated On adults and relatively little work has been repOrted abOut develOping brain death criteria fOr the yOung. Indeed the advisOrs tO the Presidents Com­ missiOn suggested that there are significant-although nOt well defined~ifferences in the ability of the brains Of thOse under five years Of age tO recOver from clinical states that WOuld be accepted as indicative Of cOmplete and irreversible lOSS of brain functiOn in adults.