Brain death in children managed at a tertiary centre in Nigeria: a five-year review

Abstract

Introduction: The recent advent of organ transplantation in Nigeria has emphasized the need for protocols in the diagnosis and management of brain death as is obtainable in developing countries in order to prevent waste of scarce resources and loss of potentially viable organ donors. Aim: To determine the aetiology and outcomes of children with brain death at the University College Hospital, Ibadan. Methods: All non-surgical paediatric patients admitted to the intensive care unit (ICU) over a five-year period were evaluated. Those with features of brain death had details of their history and physical examination findings throughout admission recorded in a proforma. The parents were counselled if the features remained consistent 24 hours after the initial assessment. Their decisions and the outcomes of the patients were documented. Results: Thirteen patients (12.1%) out of the 108 non-surgical paediatric patients had brain death, 6(46.2%) males and 7(61.5%) females. The major risk factor for brain death was intracranial infections, seen in 11 (84.6%). Others were bihemispheric cerebrovascular accident (7.7%) and tetralogy of Fallot (7.7%). All the parents were counselled and offered the option of withdrawal of care but none gave consent for withdrawal of care. All patients had a terminal cardiopulmonary arrest within 5 days of the first diagnosis of brain death. Conclusion: Brain death occurred in 12.1% of non-surgical paediatric ICU admissions in our centre with intracranial infections as the leading risk factor. Our findings emphasize the need to intensify efforts and resources in the prevention of these diseases. There is also a need for development of protocols to guide the management of brain death.