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Brief survey: Determining brain death in Canadian intensive care units

[Enquête ponctuelle : la détermination de la mort encéphalique dans les unités de soins intensifs au Canada]

Christopher James Doig, MD MSc, Kimberly Young, RN BSN, Jeannie Teitelbaum, MD and Sam D. Shemie, MD

From the Departments of Critical Care Medicine, Medicine, and Community Health Sciences,* Faculty of Medicine, The University of Calgary, Calgary, Alberta; the
Canadian Council for Donation and Transplantation;
the Department of Neurology, Montreal Neurological Institute, McGill University, Montreal, Quebec; and the
Division of Critical Care Medicine, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada.

Address correspondence to: Dr. Christopher James Doig, Associate Professor, Rm EG23G Foothills Medical Centre, 1403-29^th Street NW, Calgary, Alberta T2N 2T9, Canada. Phone: 403-944-1691; Fax: 403-283-9994; E-mail: cdoig{at}ucalgary.ca

Purpose: Criteria for brain death were first described in 1968, and Canadian guidelines were published in 1988. However, international inconsistency persists in the process of determining brain death. We sought to determine self-reported practices and processes in the determination of brain death amongst Canadian intensive care unit (ICU) physicians.

Methods: An email survey of members of the Canadian Critical Care Society was undertaken. A survey instrument was developed, then face and content validated prior to distribution.

Results: Eighty eight responded (response rate = 49%), including adult and pediatric ICU physicians working in both tertiary referral (academic) and community hospitals. Most respondents admit patients with brain death to their ICUs. However, 9% reported refusing to admit this type of patient for reasons including inappropriate utilization of ICU resources (36%), and lack of either space or staff (32% and 29% of respondents, respectively). Community hospital-based ICU physicians were less likely to report a hospital policy on the determination of brain death (46% vs 78% of physicians in tertiary care hospitals). Nearly all physicians (96%) reported that a revised national standard and checklist for the determination of death would be useful.

Conclusions: Nearly one quarter, and over one half of tertiary care and community hospitals (respectively) in Canada lack an institutional policy on neurological determination of brain death. Canadian ICU physicians are interested in a national standard for the determination of death, and establishment of processes that may improve the clinical determination of death by neurological criteria.

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