Brain death in early infancy.

Guidelines for the determination of brain death in infants and children are now well established. Coma, absence of cranial nerve reflexes, and apnea are required in all patients. In children less than 1 year of age, supportive neurodiagnostic studies (electroencephalograms and cerebral blood flow) are recommended. Data on 52 pediatric heart donor patients were reviewed to assess whether current criteria and procedures were used in the determination of brain death. The mean age of the donors (14.3 months) was higher than that of the recipients (2.6 months). In all patients the hospital records documented coma, fixed dilated pupils, absent brain stem reflexes, apnea, and verification of the diagnosis of brain death by two physicians who were not part of the transplantation team. In 27 of 52 patients, apnea challenge tests were performed; the mean PCO2 was 73.3 torr. Thirty-three of 52 patients had electroencephalograms performed; electrocerebral silence was found in 28 of 33 studies. Twenty-two of 52 patients had cerebral blood flow studies; in 19 of 22 studies the absence of flow was observed. Of the 52 patients the following number of organs were transplanted: heart (52), liver (34), kidneys (15), corneas (6), lung (4), and pancreas (2). These data indicate that the diagnosis of brain death is being made accurately and in a timely manner as is the harvesting of organs. Improvements could be made by requiring, if possible, the performance of an apnea challenge test in all patients. The data also suggest the potential to increase the donor yield.