• Journal of Chest Surgery
• /
• v.28 no.5
• /
• pp.437-442
• /
• 1995

We developed an experimental model of brain death using dogs. Brain death was caused by increasing the intracranial pressure[ICP suddenly by injecting saline to an epidural Foley catheter in five female mongrel dogs[weight, 20-25Kg .Hemodynamic and electrocardiographic changes were evaluated continuously during the process of brain death. 1. Abrupt rise of ICP after each injection of saline followed by a rapid decline to a new steady-state level within 15 minutes and the average volume required to induce brain death was 7.6$\pm$0.8ml.2. Body temperature, heart rate, mean pulmonary arterial pressure, left ventricular[LV enddiastolic pressure and cardiac output was not changed significantly during the process of brain death, but there was an increasing tendency.3. Mean arterial pressure and LV maximum +dP/dt increased significantly at the time of brain death.4. Hemodynamic collapse was developed within 140 minutes after brain death.5. Marked sinus bradycardia followed by junctional rhythm was seen in two dogs and frequent VPB`s with ventricular tachycardia was observed in one dog at the time of brain death. Hyperdynamic state develops and arrhythmia appears frequently at the time of brain death. Studies on the effects of brain death on myocardium and its pathophysiologic mechanism should be followed in the near future.

• Journal of East-West Nursing Research
• /
• v.28 no.1
• /
• pp.49-56
• /
• 2022

Purpose: This study was conducted to identify the factors affecting the attitudes toward brain death organ donation among nurses and doctors in an operating room. Methods: A descriptive research was used. The participants included 90 nurses and 30 doctors who had experience of operating organ transplantation for brain death organ donation. Data were collected from March 12 to May 23, 2020 in the one tertiary general hospital. The outcome measures were perception and attitude of death and attitude towards brain death organ donation. Results: Attitudes toward brain death organ donation was influenced by type of occupation, intention of organ donation and attitude toward death. In addition, the explanatory power of the total variance was 52.1%. Conclusions: Based on the results, it is necessary to prepare an intervention to improve awareness of the brain death and the brain death organ donation.

• Journal of Chest Surgery
• /
• v.29 no.1
• /
• pp.1-6
• /
• 1996

We developed an experimental model of brain death using dogs. Brain death was induced by increasing the intracranial pressure (ICP) gradually by continuous Infusion of saline through an epidural Foley catheter in 5 mongrel dogs (weight, 18~22kg). Hemodynamic and electrocardiographic changes were evaluated continuously during the process of brain death and obtained the following results. 1. The average volume and time required to induce brain death was 4.8$\pm$1.0ml and 143.0$\pm$30.9minutes respectively. 2. There was a steady rise of the ICP after starting the constant infusion of saline, and ICP rised continuously until the brain death (122.0$\pm$62.5mmHg). After reaching to the maximal value (125.0$\pm$47.7mmHg) at 30 minutes after brain death, the ICP dropped and remained approximately constant at the slightly higher level than the mean arterial pressure (MAP). 3. MAP showed no change until the establishment of brain death and it declined gradually. The peak heart rate reached to 172.6$\pm$35.3/min at 30 minutes after the brain death. 4. Even though the body temperature and all hemodynamic variables, such as cardiac output, mean pulmonary arterial pressure, left ventricular (LV) end-diastolic pressure and LV maximum + dp/dt, were slightly greater than those of basal state, at the point of brain death, there was no statistically significant change during t e process of brain death. 5. There was no remarkable arrhythmias during the experiment except ventricular premature beats which was observed transiently in one dog at the time of brain death. Hemodynamic changes in the brain death model induced by gradual ICP increment were inconspicuous, and arrhythmias were rarely seen. Hyperdynamic state, which was observed at the point of brain death in another brain death model caused by abrupt ICP increase, was not observed.

• Archives of Plastic Surgery
• /
• v.46 no.5
• /
• pp.405-413
• /
• 2019

Background Face transplantation has naturally evolved from reconstructive procedures. However, few institutions perform face transplantations, because it is time-consuming and it is necessary to justify non-vital organ transplantation. We investigated the process of organ donation from brain-dead patients and the possibility of incorporating face transplantation into the donation process. Methods A retrospective review was performed of 1,074 brain-dead patients from January 2015 to December 2016 in Korea. We analyzed the time intervals from admission to brain death decisions (first, second, and final), the causes of brain death, and the state of the transplanted organs. Results The patient base (n=1,074) was composed of 747 males and 327 females. The average period between admission to the first brain death decision was 8.5 days (${\pm}15.3$). The average time intervals between the first brain death decision and medical confirmation using electroencephalography and between the first brain death decision and the final determination of brain death were 16 hours 58 minutes (${\pm}14hours$ 50 minutes) and 22 hours 57 minutes (${\pm}16hours$ 16 minutes), respectively. The most common cause of brain death was cerebral hemorrhage/stroke (42.3%), followed by hypoxia (30.1%), and head trauma (25.2%). Conclusions When face transplantation is performed, the transplantation team has 22 hours 57 minutes on average to prepare after the first brain death decision. The cause of brain death was head trauma in approximately one-fourth of cases. Although head trauma does not always imply facial trauma, surgeons should be aware that the facial tissue may be compromised in such cases.

• Clinical and Experimental Pediatrics
• /
• v.52 no.8
• /
• pp.856-861
• /
• 2009

Cardiopulmonary arrest has long been accepted as an unquestionable definition of death. An advent of cardiopulmonary resuscitation and artificial ventilation along with the development of organ transplantation has prompted the emergence of the concept of brain death. The criteria for brain death are based mainly on the clinical examination of coma, apnea and total loss of brain stem function. Although organ transplantation by donor brain death has increased in Korea over recent years, there is still a substantial shortage of donor organs compared to the demand. Improvement of government policies and changes of social culture for organ donation are needed for the activation of organ transplantation by donor brain death. Pediatricians have an important role for the search of potential donors in cases of brain death and optimal medical care for successful organ transplantation.

• The Korean Journal of Health Service Management
• /
• v.5 no.1
• /
• pp.159-170
• /
• 2011

This study aims at providing basic data on brain death by analyzing factors of influencing toward attitude to brain death subject to citizens of Busan City. The data was collected for 47 days from 14 July to 31 August, 2009. Among a total of 2200 cases of the questionaries, only 2042 cases were used. For data analysis, SPSS 17.0 was used, and for the specific analysis method frequency analysis to understand general characteristics of the participants. In addition, examination on T-test and ANOVA analysis were conducted after analyzing the factors for participants' consciousness on brain death, and logistic regression analysis for understanding of relations between participants' will to brain death and general characteristics. The results of this study are summarized as follows; First, attitudes towards brain death according to general characteristics was high in those with will to donate their organs than those without in the attitude factors, namely, death recognition, acceptive, exclusive and religious attitude factors. Second, Significant variables for effects of attitudes towards brain death were gender, patients or their family's chronic or incurable diseases, religion, occupation and death recognition, acceptive, and exclusive attitude factors.

• Korean Journal of Clinical Laboratory Science
• /
• v.36 no.1
• /
• pp.64-68
• /
• 2004

Brain death is defined as the irreversible cessation of all brain function. The diagnosis of brain death is primarily based on a careful neurological examination demonstrating unresponsiveness, absent of brain stem reflexes, and no respiratory activity. Several conditions which may mimic brain death must be excluded. In some cases investigations such as electroencephalography, angiography, transcranial doppler or evoked potentials can contribute to the diagnosis. The brief review will introduce medical technologist and clinician to the key issues in the definition and management of brain death.

• Journal of Chest Surgery
• /
• v.23 no.6
• /
• pp.1204-1212
• /
• 1990

Recent social and medical developments have significantly changed both the concept of death and the criteria for its pronouncement. Instead of considering. the heart as central to the determination for death, it is now prevalent to use death of the brain as adequate for death regardless of cardiac function in most western countries. But the brain death theory is not yet legally accepted despite growing public interest in our country due mainly to customary and moral reasons. Subsequently heart transplantation, which necessitates the concept of brain death, still remains a possible surgical entity in the future. As a part of endeavor the evaluate social atmosphere for the legal acceptance of the concept of brain death and the availability of potential heart donors, a four-page questionnaire on brain death and cardiac transplantation was given to the sophomore students of a medical college in Seoul[n=116, group I] and their family members[n=83, group II ]. The groups were chosen under the assumptions that they lacked sophisticated medical knowledge but had general medical interest so reliable data could be obtained. The majority of respondents in both group I and II thought that they knew the concept of brain death[group I 99.1%, group II 93.3%] and the definition of heart transplantation[group I 94%, group II 67.6%] at least to some extent, but only a small proportion of them was proven to have correct knowledge: brain death[74.4%, group II 39. 8%], heart transplantation[group I 31.9%, group II 30.1%]. Most respondents answered in the affirmative for the legal approval of brain death[group I 87.8%, group Il 97.9%]. The possibility of medical usage of brain dead organs was the biggest reason for brain death[group I 52.9%, group Il 47.9%]. Ninety-one percent of group I and 89.1 percent of group II responded that they were willing to give permission for donating the heart of brain-dead family members. Fifty-nine percent of group I and 51.9 percent of group II wanted their own heart donated. These results suggest, despite some inherent sampling limitations, that favorable responses to brain death and heart transplantation can be obtained among the general public if they are properly informed.

• Journal of Veterinary Clinics
• /
• v.18 no.4
• /
• pp.358-362
• /
• 2001

Brain dead (BD) patients remain the largest source of solid organs for transplantation. BD has shown to decrease graft function and survival in rodent models. The aim of this study was to evaluate how brain death affects graft viability in the donor and kidney tolerance to cold preservation as assessed by survival in a canine transplantation. 13 Beagle dogs were used for the study. Brain death was induced by the sudden inflation of a subdural balloon catheter with continuous monitoring of arterial blood pressure and eletroencephalographic activity (n=3). Sixteen hours after conformation of brain death, kidney graft were retrieved (n=6). Non-BD donors served as controls (n=4). All kidneys were flushed with University of Wisconsin (UW) solution and preserved for 24 hours at 4$^{\circ}C$ before transplantation. Recipient survival rates, serum creatinine level were analyzed. Brain death induced the well-known Cushing reaction with a severe increase in blood pressure and tachycardia. Thereafter, cardiac function returned progressively to baseline within 8 hours and remained stable until the end of the experiment. All of dogs in both group transplanted were survived until 7 days (100%), and the kidneys showed functional early rejection at 8.3$\pm$0.5 days and 8.5$\pm$0.5 days after transplantation, in BD and allograft group, respectively. BD kidneys were functionally similar to control kidneys for 7 days after transplantated. Brain death has no deleterious effect on preservation injury and survival of dog kidney transplantation, although it induces changes in hemodynamic parameters. This study reveals that kidneys from BD donors do not exhibit more ischemia reperfusion injury, and support good early function and survival.

• Annals of Clinical Neurophysiology
• /
• v.19 no.2
• /
• pp.118-124
• /
• 2017

Electroencephalography (EEG) is frequently used to assist the diagnosis of brain death. However, to date there have been no guidelines in terms of EEG criteria for determining brain death in Korea, despite EEG being mandatory. The purpose of this review is to provide an update on the evidence and controversies with regarding to the utilization of EEG for determining brain death and to serve as a cornerstone for the development of future guidelines. To determine brain death, electrocerebral inactivity (ECI) should be demonstrated on EEG at a sensitivity of $2{\mu}V/mm$ using double-distance electrodes spaced 10 centimeters or more apart from each other for at least 30 minutes, with intense somatosensory or audiovisual stimuli. ECI should be also verified by checking the integrity of the system. Additional monitoring is needed if extracerebral potentials cannot be eliminated. Interpreting EEG at high sensitivities, which is required for the diagnosis of brain death, can pose a diagnostic challenge. Furthermore, EEG is affected by physiologic variables and drugs. However, no consensus exists as to the minimal requirements for blood pressure, oxygen saturation, and body temperature during the EEG recording itself, the minimal time for observation after the brain injury or rewarming from hypothermia, and how to determine brain death when the findings of ECI is equivocal. Therefore, there is a strong need to establish detailed guidelines for performing EEG to determine brain death.