PT  - JOURNAL ARTICLE
AU  - Lewis, Ariane
AU  - Bakkar, Azza
AU  - Kreiger-Benson, Elana
AU  - Kumpfbeck, Andrew
AU  - Liebman, Jordan
AU  - Shemie, Sam D.
AU  - Sung, Gene
AU  - Torrance, Sylvia
AU  - Greer, David
TI  - Determination of death by neurologic criteria around the world
AID  - 10.1212/WNL.0000000000009888
DP  - 2020 Jul 21
TA  - Neurology
PG  - e299--e309
VI  - 95
IP  - 3
4099  - http://n.neurology.org/content/95/3/e299.short
4100  - http://n.neurology.org/content/95/3/e299.full
SO  - Neurology2020 Jul 21; 95
AB  - Objective To identify similarities and differences in protocols on determination of brain death/death by neurologic criteria (BD/DNC) around the world.Methods We collected and reviewed official national BD/DNC protocols from contacts around the world between January 2018 and April 2019.Results We communicated with contacts in 136 countries and found that 83 (61% of countries with contacts identified, 42% of the world) had BD/DNC protocols, 78 of which were unique. Protocols addressed the following prerequisites and provided differing instructions: drug clearance (64, 82%), temperature (61, 78%), laboratory values (56, 72%), observation period (37, 47%), and blood pressure (34, 44%). Protocols did not consistently identify the same components for the clinical examination of brain death; 70 (90%) included coma, 70 (90%) included the pupillary reflex, 68 (87%) included the corneal reflex, 67 (86%) included the oculovestibular reflex, 64 (82%) included the gag reflex, 62 (79%) included the cough reflex, 58 (74%) included the oculocephalic reflex, 37 (47%) included noxious stimulation to the face, and 22 (28%) included noxious stimulation to the limbs. Apnea testing was mentioned in 71 (91%) protocols; there was variability in the technique and target across protocols. Ancillary testing was included as a requirement for all determinations of BD/DNC in 22 (28%) protocols.Conclusions There is considerable variability in BD/DNC determination protocols around the world. Medical standards for death should be the same everywhere. We recommend that a worldwide consensus be reached on the minimum standards for BD/DNC.BD/DNC=brain death/death by neurologic criteria; IQR=interquartile range