Significance of SPECT as a Confirming Test of the Brain Death / 대한이식학회지

ABSTRACT

In Korea, brain death was established by the law in year 2000 but organ procurements from brain dead donors have been performed before the law era under the social tacit approval. Contrary to expectations, organ transplantation from brain dead donor have been much decreased in the law era. Electroencephalogram (EEG) is mandatory to confirm brain death in Korea. However EEG has several shortcomings and EEG wave may persist several hours after declaration of brain death by other tests. PURPOSE: To evaluate the significance of EEG and single photon emission computerized tomography (SPECT) as a confirming test of the brain death. METHODS: Clinical records of 42 cadaveric donor and their kidney recipients were reviewed retrospectively. Flat EEG was declared by two board certified neurologist or neurosurgeon. Tc99m-ECD SPECT was done in recent 10 donors who didn't show flat EEG at 24 hours after declarartion of brain death on clinical examination. And compared interval from renal transplantation to the moment when serum creatinine level went down below 2.0 mg/dl. RESULTS: Among 42 donors, 3 went to cardiac arrest while waiting flat EEG. And one another donor also went to cardiac arrest just after taking flat EEG. All the ten donors who took brain SPECT showed absence of cerebral blood flow. After showing circulatory arrest to the brain on SPECT another 3 to 23 hours were needed to get the flat EEG. There was no difference in interval between EEG only group (9.8 days) and EEG plus SPECT group (9.2 days). But the interval was prolonged in cardiac arrest group up to 20 days. CONCLUSION: We could get the falt EEG 3 to 23 hours after circulatory arrest to the brain on SPECT scan. While waiting to get flat EEG three donors went to cardiac arrest and kidneys from these cardiac arrest donor showed delayed graft function in all cases. Brain SPECT should be used as a confirming test of brain death.