Organ transplantation after brain death (BD) of the donor has been promoted in many countries as an established medical treatment. However, some problems with brain-dead organ transplantation have been reported. For example, there is no evidence as to the optimal observation period for a diagnosis and no evidence to support the interpretation of the various body movements observed after the determination of BD.
A previously healthy 17-month-old girl with severe febrile convulsive status was transferred to our intensive care unit. The convulsions were refractory and the patient required respiratory management due to whole brain edema on head CT. Later she was diagnosed with acute encephalopathy. The patient showed a flat EEG, no responses on auditory brainstem responses (ABR), and loss of brainstem reflexes on repeated daily examinations. No apnea test was performed. Based on the diagnosis of clinical BD, coordinator of Japan Organ Transplant Network explained about organ donation on the 17th day of the disease. Subsequently, the family responded that they could not consent to organ donation, and the patient did not proceed to the legal BD determination. Around five weeks after the onset, spontaneous body movements began to appear, as not only the spinal reflexes but also the brainstem involvement.
The pathophysiology of acute encephalopathy is largely unknown, and it is difficult to determine the observation period necessary for BD determination. What we have learned from this case is that clinical BD remains ambiguous and cannot be confirmed even with a thorough neurological examination, EEG, and ABR.
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- Current status of pediatric transplantation in Japan.J Intensive Care. 2017; 5: 48
- Current controversies in brain death determination.Nat Rev Neurol. 2017; 13: 505-509
- Brain death criteria: Medical dogma and outliers.Yale J Biol Med. 2019; 92: 751-755
- American Academy of Neurology. Evidence-based guideline update: Determining brain death in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology.Neurology. 2010; 74: 1911-1918
- The lower limb flexion reflex in humans.Prog Neurobiol. 2005; 77: 353-395
- Phenomenological diversity of spinal reflexes in brain death.Eur J Neurol. 2000; 7: 315-321
- Spontaneous and reflex movements in 107 patients with brain death.Am J Med. 2005; 118: 311-314
- The role of a trigeminal sensory nucleus in the initiation of locomotion.J Physiol. 2012; 590: 2453-2469
- Acute encephalopathy associated with influenza and other viral infections.Acta Neurol Scand. 2007; 115: 45-56
- Unusual spontaneous movements in brain-dead patients.Neurology. 1985; 35: 1082
Published online: June 23, 2022
Accepted: June 10, 2022
Received in revised form: June 10, 2022
Received: February 8, 2022
© 2022 The Japanese Society of Child Neurology Published by Elsevier B.V. All rights reserved.