Hannah Wiest1, Miriam Quinlan1, Ilana Harwayne-Gidansky1, John Pugh1
1Albany Medical Center
Background:
Pediatric brain death (BD) determination has been controversial since concept inception in 1987. Given the gravity of making a pediatric BD determination, methodical adherence to the AAN Brain Death/Death by Neurologic Criteria (BD/DNC) practice guideline is paramount. Just as checklists are used for the clinical portions of BD determination, we propose a checklist be used as an ethical framework to guide clinicians in considering emotional, cultural, and social aspects of the patient's care.
Design/Methods:
We developed an acronym to guide pediatric BD determination based on a literature review of ethical and philosophical dilemmas surrounding pediatric BD/DNC, the 2023 AAN guidelines, and expert consensus.
Results:
We propose the CARES acronym: Communication, Accommodation, Resource Sharing, Examination, and Support to further guide clinicians in declaring brain death in pediatric populations. Communication will shift from notification of beginning BD/DNC determination to an invitation for family participation, with explanation of the process at every step. Accommodation encompasses providing space for addressing religious or cultural beliefs. Resource sharing by consultation from the ethics or palliative care teams can aid clinicians in effectively counseling families. The examination for BD/DNC determination should adhere to the 2023 AAN guidelines. Finally, support should be offered throughout the process with a focus on helping families cope, grieve, and process.
Conclusions:
Creating a stepwise, family-centered approach to pediatric BD can guide caregivers and families through the difficult process of pediatric BD declaration.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.