CHALLENGES AND BARRIERS OF BRAIN DEATH REPORTING IN MALAYSIA

Abstract

Background: This study aims to describe barriers in diagnosing brain death by categorizing the data analysed from the National Transplant Procurement Management Unit (NTPMU) Registry.

Materials and Methods: Data records of the NTPMU registry from 2018-2019 were extracted. These data were analysed to describe the following: (i) Brain death proportion; (ii) Demographic characteristics; (iii) Admission and brain death test characteristics; (iv) Reason for brain death test not done and; (v) Correlations.

Result: A total of 772 referrals were made, of which 322 were suspected for brain death. Out of this, 126 cases were confirmed for brain death, whereas 27 consented for organ donation. The proportion of confirmed brain deaths from the reported total deaths from 2018-2019 is 15.8%. Neurosurgical (57.5%) and intensive care (78.1%) units reported for the most referrals made. Severe traumatic brain injury (39.2%) and spontaneous intracranial haemorrhage (41.8%) are the two most frequent causes of admission with suspected brain death. Unable to correct parameters (34.7%), cardiac death before test was done (31.2%) and no clearance from family (21.2%) are the most frequently reported causes for brain death test not done. Selected variables showed no correlation with duration between first and second brain death tests.

Conclusion: A sound understanding in clinical knowledge and awareness among healthcare workers, a well-structured brain death consensus statement, properly executed training to improve attitudes and a well-managed awareness campaigns directing to the public are critical in overcoming the barriers in brain death diagnosis.

Keywords: Barriers, brain death diagnosis, organ donation, Malaysia, organ transplant