AWARENESS OF BRAIN DEATH DOCUMENTATION AMONG POST GRADUATE TRAINEES IN LAHORE
Keywords:Brain death, Diagnostic recommendation, Organ transplant, Postgraduate Knowledge
Brain death is the complete and irreversible cessation of all activity in the brain, including the brain stem and cortex. It's critical to declare someone brain dead to stop providing life support or donating their organs. This study was carried out to evaluate postgraduate trainee doctors’knowledge and understanding of brain death in the Lahore cityas the Punjab Human Organ Transplant Authority (PHOTA) moves towards cadaveric donor program. Utilizing the universal sample approach, a questionnaire-based survey with 150 senior trainee registrars from several postgraduate fields was conducted at four teaching hospitals in Lahore. The registrars had 45 minutes to finish a pre-validated questionnaire form that inquired about their perspectives, knowledge, and the procedure for determining brain death. Quantitative data were shown as means, whereas qualitative data was shown as frequencies. SPSS software version 21 was used for statistical analysis. The questionnaire was given to 150 postgraduate trainees in total, of which 70% were men and 30% were women. Approximately 88.90% of participants were able to define brain death as the total cessation of all brain functioning, including brainstem reflexes. 121 doctors (82%) said yes when asked if they would perform brainstem reflexes twice, six hours apart. Only 40(26.66%) doctors were able to reliably identify the absence of brain stem responses, such as the corneal and pupillary reflexes. Just 10 (6.66%) out of 150 participants were able to correctly define what a positive apnea test means, but 33.33% of respondents agreed that it is a necessary test to demonstrate the cessation of brain stem activity. 15.50% of resident doctors had knowledge that a committee of four doctors was required to declare brain deathThe gold standard test for determining brain death, according to 4.66% of responders, is cerebral angiography. 95% of respondents were ignorant of the measures being taken by the Punjab Human Organ Authority (PHOTA) concerning the dead organ harvesting program or that such a program even existed. Although everyone agreed that getting an agreement before organ harvesting was required but only five trainees understood the exactmethodologyof taking consent and how it functioned. The PGRs lacked knowledge about brain death, its detection and documentation, concerning cadaveric donor organ donation and transplantation. The results of this study showed a lot of work needed to start cadaveric organ transplant safely.
Balwani, M. R., Gumber, M. R., Shah, P. R., Kute, V. B., Patel, H. V., Engineer, D. P., Gera, D. N., Godhani, U., Shah, M., and Trivedi, H. L. (2015). Attitude and awareness towards organ donation in western India. Renal failure37, 582-588.
Bernat, J. L., and Dalle Ave, A. L. (2019). Aligning the criterion and tests for brain death. Cambridge Quarterly of Healthcare Ethics28, 635-641.
Burkle, C. M., Sharp, R. R., and Wijdicks, E. F. (2014). Why brain death is considered death and why there should be no confusion. Neurology83, 1464-1469.
Citerio, G., Crippa, I. A., Bronco, A., Vargiolu, A., and Smith, M. (2014). Variability in brain death determination in Europe: looking for a solution. Neurocritical care21, 376-382.
De Groot, J., van Hoek, M., Hoedemaekers, C., Hoitsma, A., Smeets, W., Vernooij-Dassen, M., and van Leeuwen, E. (2015). Decision making on organ donation: the dilemmas of relatives of potential brain dead donors. BMC Medical Ethics16, 1-11.
Greer, D. M., Shemie, S. D., Lewis, A., Torrance, S., Varelas, P., Goldenberg, F. D., Bernat, J. L., Souter, M., Topcuoglu, M. A., and Alexandrov, A. W. (2020). Determination of brain death/death by neurologic criteria: the world brain death project. Jama324, 1078-1097.
Kapinos, G., and Ala, T. A. (2021). When Determining Brain Death in Adults, Time Is of the Essence!: The Last Nail in the Coffin of Dual Examination in Brain Death. Vol. 96, pp. 469-470. AAN Enterprises.
Manara, A., Varelas, P., and Wijdicks, E. F. (2019). Brain death in patients with “isolated” brainstem lesions: a case against controversy. Journal of neurosurgical anesthesiology31, 171-173.
Martin-Loeches, I., Sandiumenge, A., Charpentier, J., Kellum, J. A., Gaffney, A. M., Procaccio, F., and Westphal, G. A. (2019). Management of donation after brain death (DBD) in the ICU: the potential donor is identified, what's next? Intensive care medicine45, 322-330.
Nair-Collins, M., and Joffe, A. R. (2021). Frequent preservation of neurologic function in brain death and brainstem death entails false-positive misdiagnosis and cerebral perfusion. AJOB neuroscience, 1-14.
Nakagawa, T. A., Ashwal, S., Mathur, M., Mysore, M., and Children, C. F. D. O. B. D. I. I. (2012). Guidelines for the determination of brain death in infants and children: an update of the 1987 task force recommendations—executive summary. Annals of neurology71, 573-585.
Randhawa, G., and Schicktanz, S. (2013). Public engagement in organ donation and transplantation. World20, 23.
Russell, J. A., Epstein, L. G., Greer, D. M., Kirschen, M., Rubin, M. A., and Lewis, A. (2019). Brain death, the determination of brain death, and member guidance for brain death accommodation requests: AAN position statement. Neurology92, 228-232.
Shemie, S. D., and Gardiner, D. (2018). Circulatory arrest, brain arrest and death determination. Frontiers in Cardiovascular Medicine5, 15.
Shemie, S. D., Hornby, L., Baker, A., Teitelbaum, J., Torrance, S., Young, K., Capron, A. M., Bernat, J. L., and Noel, L. (2014). International guideline development for the determination of death. Intensive care medicine40, 788-797.
Su, Y., Zhang, Y., Chen, W., Tian, F., Fan, L., Liu, G., Huang, H., Zhang, Y., Wang, J., and Deng, Y. (2022). Minimum Criteria for Brain Death Determination: Consensus Promotion and Chinese Practice. Neurocritical Care, 1-8.
Sulania, A., Sachdeva, S., Jha, D., Kaur, D., and Sachdeva, R. (2016). Organ donation and transplantation: An updated overview. MAMC Journal of Medical Sciences2, 18-27.
Varelas, P. N., Rehman, M., Mehta, C., Louchart, L., Schultz, L., Brady, P., Kananeh, M. F., and Wijdicks, E. F. (2021). Comparison of 1 vs 2 brain death examinations on time to death pronouncement and organ donation: a 12-year single center experience. Neurology96, e1453-e1461.
Vincent, A., and Logan, L. (2012). Consent for organ donation. British journal of anaesthesia108, i80-i87.
Wijdicks, E. F. (2012). The transatlantic divide over brain death determination and the debate. Brain135, 1321-1331.
Youn, T. S., and Greer, D. M. (2014). Brain death and management of a potential organ donor in the intensive care unit. Critical care clinics30, 813-831.
Zimmermann, C. J., Baggett, N. D., Taylor, L. J., Buffington, A., Scalea, J., Fost, N., Croes, K. D., Mezrich, J. D., and Schwarze, M. L. (2019). Family and transplant professionals’ views of organ recovery before circulatory death for imminently dying patients: A qualitative study using semistructured interviews and focus groups. American Journal of Transplantation19, 2232-2240.
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Copyright (c) 2022 MA RANA, AHA AWAD, MA QAYYUM, MA KHALID, MA BHATTI, S ZARTASH, M ZAHOOR, R PERVAIZ, MN HAFEEZ
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