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Brain Death Determination Practices in Children-Reply

Murray M. Pollack, MD; Rodrigo E. Mejia, MD
JAMA. 1995;274(22):1762. doi:10.1001/jama.1995.03530220027024.
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In Reply.  —Dr Lynch seems to have missed the central point of our study. Rather than survey how physicians claim they practice, as she did,1 we evaluated how physicians actually practiced in individual brain death cases. Ours was the first large prospective study of a diverse, randomly selected group of PICUs that evaluated actual clinical practices used in the determination of brain death of individual patients. We found that brain death criteria used in individual cases differed substantially within single PICUs as well as among units. We also found that some brain death determination practices were controversial. Brain death determination practices frequently were inconsistent with those recommended by the Task Force for the Determination of Brain Death in Children.2Lynch and Eldadah1 surveyed a homogeneous group of PICUs, those with critical care fellowships. That report does not detail the qualifications of those responding to the questionnaire or


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