Results of surveys on brain-death determination: Report from the Neuroemergency section of the Japanese Society of Neurology

There are very few organ transplants from brain-dead donors (BD transplants) in Japan compared with other countries. The neuroemergency section of the Japanese Society of Neurology (JSN) conducted a survey on the participation of neurologists in BD determination. The target of the survey was educational and quasi-educational institutions of the JSN. It was found that neurologists served as doctors to legally declare BD in 38% of institutions. Many institutions had neurological staffs with the skills required for BD determination, such as EEG reading (97%), neurological evaluations of BD (93%), judgment of the apnea test (75%), or interpretation of auditory brainstem responses (67%). As many as 96% of the responders considered that neurologists should participate in legal BD determination, although 20% felt that the lack of human resources prevented them from active participation. An inquiry to the Japan Organ Transplant Network revealed that neurologists served as a doctor to legally declare BD in around 80% of legal BD determination cases so far. The neuroemergency section conducted another survey regarding the duration of high-sensitivity and bipolar recording in EEG for BD determination. This was because simplification of EEG recording was planned for the revision of the official manual for legal BD determination. It was found that high-sensitivity and bipolar recording was conducted for 15 minutes or shorter in 52% of institutions. Many existing overseas as well as Japanese guidelines require 30-minute EEG recording for BD determination. However, the only basis was the reports of two cases with drug intoxication in whom EEG reappeared after 20 minutes' electrocerebral inactivity: such patients would not be candidates for donors according to the Japanese guideline. Based on the present results, the minimal required duration of (high-sensitivity and bipolar) EEG recording for legal BD determination was shortened to 15 minutes in the revised manual.