Determination of Brain Death/Death by Neurologic Criteria in Countries in Asia and the Pacific

Background and Purpose We sought to 1) identify countries in Asia and the Pacific that have protocols for the determination of brain death/death by neurologic criteria (BD/DNC) and 2) review the similarities and differences of these protocols in different countries. Methods Between January 2018 and April 2019, we attempted to communicate with contacts in the 57 countries in Asia and the Pacific to determine if they had official national BD/DNC protocols. We reviewed and compared the identified protocols. Results We identified contacts for 40 (70%) of the 57 countries in Asia and the Pacific, and successfully communicated with 37 of them (93% of countries with contacts identified, 65% of countries in Asia and the Pacific). We found that 24 of the 37 countries had BD/DNC protocols. Two (13%) of the 16 protocols that provided a definition of death referred to brainstem death. Kazakhstan and Israel required only 1 examination to declare BD/DNC, while 10 (71%) of the other 14 protocols required 2 examinations separated by 6-48 hours. The prerequisites, clinical examination, apnea testing procedure, and indications for/selection of ancillary tests varied. Ancillary testing was required for all determinations of BD/DNC in five (21%) countries. Thirteen (54%) of the protocols included information about the time of death, while 12 (50%) of them provided instructions about discontinuation of organ support. Conclusions The protocols for conducting a BD/DNC determination vary markedly among countries in Asia and the Pacific. Since it is optimal to have internationally and intranationally consistent BD/DNC protocols, efforts should be made to harmonize protocols both within this region and worldwide.