Pediatric Brain Death and Organ/Tissue Retrieval

The death 'Of a child, 'One wh'Ose vulnerability and unfilled promise c'Omp'Ounds the tragedy 'Of any death, t'Ouches us deeply. When that death 'Occurs due t'O the generally unexpected and sudden loss 'Of brain functi'On, it is particularly P'Oignant. And yet, when death c'Omes, it sh'Ould be diag- nosed expediti'Ously. The professi'Onal resP'Onsibilities 'Of the physician require that he b'Oth rec- 'Ognize brain death and inf'Orm the family 'Of its occurrence. In additi'On, since recent advances in transplantati'On provide the P'Ossibility 'Of using the 'Organs 'Of a brain-dead child t'O save the lives 'Of 'Other children, the c'Oncepts 'Of beneficence an~ charity further c'Ompel physicians t'O facilitate such transplantati'Ons by inf'Orming the family about this P'Ossibility. Criteria 'Of brain death have been refined 'Over about 30 years since the term coma depasse (bey'Ond c'Oma) was coined by M'Ollaret and G'Oulon in 1957 (Kaufman and Lynn, 1986). The last maj'Or criteria ev'Olved 'On a nati'Onal level were th'Ose 'Of the President's C'Ommissi'On in 1981. H'Owever, studies t'O date have c'Oncentrated 'On adults, and relatively little work has been rep'Orted ab'Out devel'Oping brain death criteria f'Or the y'Oung. Indeed, the advis'Ors t'O the President's Com- missi'On suggested that there are significant-although n'Ot well defined~ifferences in the ability of the brains 'Of th'Ose under five years 'Of age t'O rec'Over from clinical states that W'Ould be accepted as indicative 'Of c'Omplete and irreversible l'OSS of brain functi'On in adults.