Brain death - Understanding of the conceptual basis by pediatric intensivists in Canada

Objective: To determine whether pediatric intensivists in Canada are aware of the controversies regarding the concept of brain death ( BD). Design: Prospective survey. Setting: From February to April 2004, a survey was mailed to each intensivist in the 15 pediatric intensive care units across the 8 provinces of Canada. Participants: Sixty-four practicing pediatric intensivists. Main Outcome Measures: Response rate, conceptual reasons to explain why BD is equivalent to death, and clinical findings that exclude a diagnosis of BD. Results: Of the 64 surveys, 54 (84%) were returned. When asked to choose a conceptual reason to explain why BD is equivalent to death, 26 (48%) chose a higher brain concept, 17 (31%) chose a prognosis concept, and only 19 (35%) chose a loss of integration of the organism concept. More than half the respondents answered that BD is not compatible with electroencephalographic activity, brainstem evoked potential activity, or some cerebral blood flow. More than a third of respondents answered that a brainstem with minimal microscopic damage was not compatible with BD. Of the 36 respondents who answered they were comfortable diagnosing BD because "the conceptual basis of brain death makes it equivalent to death of the patient," in their own words, only 8 (22%) used a loss of integration of organism concept, 9 (25%) used a prognosis concept, 7 (19%) used a higher brain concept, and 13 (36%) did not articulate a concept. Conclusions: There is significant confusion about the concept of BD among pediatric intensivists in Canada. The medical community should reconsider whether BD is equivalent to death.