Monitoring Death by Neurological Criteria and Identifying Barriers for Brain Death Diagnosis at Yangon General Hospital, Myanmar

Ohnmar O, Kyaw MK, Kyaw M, Myint Mz, Thein MMZ, Oo Sa, Lay PP and Thit WM

Published on: 2021-10-20

Abstract

Objective: To study the monitoring of death by neurological criteria and to identify the barriers for brain death diagnosis.

Method: Consecutive probable and confirmed brain-dead cases in the main intensive care unit (ICU) and neurosurgical ICU of Yangon General Hospital were identified prospectively for 6 months from 20th February to 19th August 2020 and their inpatient admission records were studied to monitor what happened after diagnosing as probable brain-dead cases, identifying the barriers for those cases to become confirmed brain death.

Results: A total of only 7 cases were recruited. Most common cause of brain dead was traumatic brain injury (TBI). Because of communicable diseases, nearly half of the cases were found unsuitable for organ donation. Nearly all cases were severe and transferred to ICU within 24 hours from admission. Average observation period (8.9 ± 8.5 hours) was longer than stated in local guideline. All cases were taken off the ventilator only after circulatory arrest. According to the definition set in this study, all probable brain dead cases did not become confirmed brain dead because of poor documentation and lack of enough knowledge of brain dead determination and expertise.

Conclusions: This study helped us understand the current hospital situation regarding brain-dead diagnosis and identified the causes for not being progressed to confirmed brain death. Future solutions will be improving knowledge and expertise on brain death certification process, practicing proper documentation of brain death and increasing awareness of possibility of organ donation among health care providers in order to improve deficiencies and challenges in practice.