Many thanks to Gene Sung, MD, Director of Critical Care at LAC-USC Medical Center, Los Angeles, CA, for discussing his recent paper "Determination of Brain Death"—The World Brain Death Project. This monumental work took five years to complete and includes input from experts in 45 countries (JAMA 2020;324(11):1078-1097).
The paper proposes uniformity of the clinical definition of brain death. Dr. Sung related that his academic interest in brain death began many years ago as a medical student when a mentor's work inspired him to learn more about this vital topic.
About ten years ago, as incoming President of the Neurocritical Care Society, he hoped to standardize brain death determination. Since a current World Health Organization (WHO) project had the same goal, he deferred to them. However, when the WHO project failed to deliver, Dr. Sung started the current project. The World Federations of Intensive Care, Pediatric Intensive Care, and Neurology and Neurosurgery became the project's backbone.
Dr. Sung explained why conformity is crucial in brain death determination. He discussed the difference between the 1968 Harvard Brain Death Criteria and the current World Brain Death Project Guidelines. For example, one brain death examination is now sufficient, rather than two separate assessments 24 hours apart. The paper also provides a foundation of knowledge regarding brain death.
Clinicians should note that the new brain death guidelines will not substantially change the current practice of brain death determination in the US and many other Western countries, which have similar protocols. It also provides a model for countries that do not yet have clinical brain death determination standards.
Dr. Sung emphasized the importance of excluding confounders, such as hypothermia and medications, which could confound brain death determination. The new guidelines have been well-received by the American Academy of Neurology and many other professional societies. Dr. Sung deserves congratulations for obtaining participation and consensus from so many different organizations and countries and completing such an ambitious and important project.
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