Subscribe to RSS
DOI: 10.1055/s-0035-1547539
Brain Death: The Asian Perspective
Publication History
Publication Date:
03 April 2015 (online)

Abstract
Asia is the largest and most populous continent in the world with people from many diverse ethnic groups, religions and government systems. The authors surveyed 14 countries accounting for the majority of Asia's population and found that, although the concept of brain death is widely accepted, there is wide variability in the criteria for certification. Although most Asian countries have adopted the “whole-brain” concept of brain death, most countries with past colonial links to the United Kingdom follow the UK “brainstem” concept of brain death. Despite this difference, most countries require only neurologic testing of irreversible coma and absent brainstem reflexes as criteria for certification of brain death. Variability exists in the number of personnel required, qualifications of certifying doctors, need for repeat examination, minimum time interval between examinations, and requirement for and choice of confirmatory tests.
-
References
- 1 Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death. A definition of irreversible coma. JAMA 1968; 205 (6) 337-340
- 2 Wijdicks EF. Brain death worldwide: accepted fact but no global consensus in diagnostic criteria. Neurology 2002; 58 (1) 20-25
- 3 Wijdicks EF. The clinical criteria of brain death throughout the world: why has it come to this?. Can J Anaesth 2006; 53 (6) 540-543
- 4 Brain Injury Evaluation Quality Control Centre of National Health and Family Planning Commission. Criteria and practical guidance for determination of brain death in adults (BQCC version). Chin Med J (Engl) 2013; 126 (24) 4786-4790. Available at: http://www.cmj.org/ch/reader/create_pdf.aspx?file_no=20132199&flag=1&year_id=2013&quarter_id=24 . Accessed December 2, 2014
- 5 Su Y, Yang Q, Liu G , et al. Diagnosis of brain death: confirmatory tests after clinical test. Chin Med J (Engl) 2014; 127 (7) 1272-1277
- 6 Japan Organ Transplant Network Homepage. Available at: http://www.jotnw.or.jp/english/index.html . Accessed December 2, 2014
- 7 Natori Y. Legal determination of brain death. JMAJ 2011; 54 (6) 363-367
- 8 Enforcement of Amended Organ Transplantation Law. June 2011. Office for Organ Transplantation Health Service Bureau Ministry of Health, Labor and Welfare. Available at: http://www.mhlw.go.jp/english/policy/health-medical/health/dl/enforcement.pdf . Accessed December 2, 2014
- 9 Aruga T. Revised Organ Transplant Act and critical care physicians. JMAJ 2011; 54 (6) 368-374
- 10 Joo HN. The organ transplantation act and recent trends in Korea. Asia Pac J Public Health 2013; 25 (2) 209-213 Available at: http://aph.sagepub.com/content/25/2/209 . December 2, 2014
- 11 Joo J. Management of brain-dead donors in Korea. J Korean Med Assoc 2014; 57 (2) 137-142
- 12 Lee SD, Kim JH. Changes in the organ procurement system in South Korea: effects on brain-dead donor numbers. Transplant Proc 2009; 41 (9) 3551-3555
- 13 Brain death guidelines in Taiwan. Available at: http://law.moj.gov.tw/LawClass/LawAll.aspx?PCode=L0020079 . December 2, 2014
- 14 Hong Kong Society of Critical Care Medicine Position Statement. Guidelines on certification of brain death. Available at: http://www.hksccm.org/index.php?option=com_content&view=article&id=1118:2009-sep-14-guidelines-on-certification-of-death-following-the-irreversible-cessation-of-brainstem-function&catid=91&Itemid=69&lang=en . Accessed December 2,2014
- 15 Organ Donation Act of 1991. Republic of the Philippines. Available at: http://www.hksccm.org/index.php?option=com_content&view=article&id=1118&lang=en . Accessed December 2, 2014
- 16 Establishment of a national program for sharing of organs from deceased donors. Administrative order no 2010–0019. Republic of the Philippines. Department of Health. Available at: http://www1.umn.edu/humanrts/research/Philippines/DOH%20Adm.%20Order%202010-0019%20on%20Organ%20Trafficking.pdf . Accessed December 2, 2014
- 17 Brain death and organ donation, Thailand. Available at: http://www.med.cmu.ac.th/secret/meded/Mede7/%B5%E9%B9%A9%BA%D1%BA/MEDE07PDF/Chapter03%20MEDE07.pdf . Accessed December 2, 2014
- 18 Tungsiripat R, Tangcharoensathien V. Regulation of organ transplantation in Thailand. Does it work?. Available at: http://r4d.dfid.gov.uk/pdf/outputs/healthecfin_kp/wp04_03.pdf . Accessed December 2, 2014
- 19 Consensus statement on Brain Death. 2003. Ministry of Health Malaysia. Available at: http://www.moh.gov.my/images/gallery/orga/Consensus%20statement%20on%20brain%20death%202003.pdf . Accessed December 2, 2014
- 20 Guideline of the Malaysian Medical Council. 2006. MMC Guideline 08/2006. Available at: http://www.moh.gov.my/images/gallery/orga/Brain%20Death%20-%20Malaysian%20Medical%20Council.pdf . Accessed December 2, 2014
- 21 Manual on Organ Donation and Transplantation. Singapore: Ministry of Health Singapore; 2013
- 22 Brain death diagnosis and clinical application. Indonesia. Available at: http://www.academia.edu/6887735/Brain_Death_Diagnosis_and_Clinical_Application . Accessed December 2,2014
- 23 Brain death and organ donation in Indonesia. Available at: http://www.hukor.depkes.go.id/up_prod_permenkes/PMK%20No.%2037%20Th%202014%20ttg%20Penentuan%20Mati%20dan%20Pemanfaatan%20Organ%20Donor.pdf . Accessed December 2, 2014
- 24 Agarwal SK, Srivastava RK, Gupta S, Tripathi S. Evolution of the transplantation of human organ act and law in India. Transplantation 2012; 94 (2) 110-113
- 25 The Transplantation of Human Organs (Amendment) Bill. 2009. Available at: http://www.prsindia.org/uploads/media/Organ%20transplantation/Legislative%20Brief%20-%20Transplantation%20of%20human%20organs%20Bill%202009.pdf . Accessed December 2, 2014
- 26 Sethi NK, Sethi PK. Brainstem death: implications in India. J Assoc Physicians India 2003; 51: 910-911
- 27 Sri Lanka. In: World Health Organization, Legislative Responses to Organ Transplantation. Leiden, The Netherlands: Martinus Nijhoff Publishers; 1994: 349-352
- 28 Rohan RP. A brain death: concepts and confusion among medical experts, legal authorities and general public in Sri Lanka. Galle Med J 2008; 13 (1) 48-50
- 29 Walallawita LD. Brainstem death and organ donation. Sri Lankan J Anaesthesiology 2009; 17 (2) 95-98
- 30 Wijdicks EF. The diagnosis of brain death. N Engl J Med 2001; 344 (16) 1215-1221
- 31 Lustbader D, O'Hara D, Wijdicks EF , et al. Second brain death examination may negatively affect organ donation. Neurology 2011; 76 (2) 119-124
- 32 Varelas PN, Rehman M, Abdelhak T , et al. Single brain death examination is equivalent to dual brain death examinations. Neurocrit Care 2011; 15 (3) 547-553
- 33 Wijdicks EF. The case against confirmatory tests for determining brain death in adults. Neurology 2010; 75 (1) 77-83
- 34 Young GB, Shemie SD, Doig CJ, Teitelbaum J. Brief review: the role of ancillary tests in the neurological determination of death. Can J Anaesth 2006; 53 (6) 620-627
- 35 World Health Organization. WHO Report – Ethics, Access and Safety in Tissue and Organ Transplantation: Issues of Global Concern. Geneva, Switzerland: WHO; 2003
- 36 Vathsala A. Improving cadaveric organ donation rates in kidney and liver transplantation in Asia. Transplant Proc 2004; 36 (7) 1873-1875
- 37 Wada issue. Available at: https://www.jstage.jst.go.jp/article/ihj1960/36/1/36_1_13/_pdf . Accessed December 2, 2014
- 38 Tai MC. An Asian perspective on organ transplantation. Wien Med Wochenschr 2009; 159 (17-18) 452-456
- 39 Keown D. Buddhism, brain death and organ transplantation. J Buddh Ethics 2010; 17: 1-36
- 40 Metz W. The Enlightened One: Buddhism. In: Beaver RP, Bergman J, Langley MS, , eds. The World's Religions. Oxford: Lion; 1982: 222-244
- 41 Bresnahan MJ, Mahler K. Ethical debate over organ donation in the context of brain death. Bioethics 2010; 24 (2) 54-60
- 42 Hardacre H. Response of Buddhism and Shinto to the issue of brain death and organ transplant. Camb Q Healthc Ethics 1994; 3 (4) 585-601
- 43 Firth S. End-of-life: a Hindu view. Lancet 2005; 366 (9486) 682-686
- 44 Hinduism and Organ Donation. Available at: http://www.organdonation.nhs.uk/how_to_become_a_donor/religious_perspectives/leaflets/hindu_dharma_and_organ_donation.asp . Accessed December 19, 2014
- 45 Organ transplant in Islam. Available at: http://www.muis.gov.sg/cms/uploadedFiles/MuisGovSG/Religious/OOM/Resources/Muis%20kidney%20book%20ENG.pdf . Accessed December 2, 2014
- 46 Sharif A. Organ donation and Islam-challenges and opportunities. Transplantation 2012; 94 (5) 442-446