Brain death: concepts and knowledge amongst health professionals in province of Sindh, Pakistan

OBJECTIVE: Last few decades have seen improved resuscitative measures and use of life saving machines like ventilators. Due to these dramatic interventions, end of life decisions, including brain death and organ transplantation, have become more complex and a major problem in our clinical practice. This study was done to find the opinion and awareness of physicians regarding issues surrounding brain death in this region. METHODS: A total of 259 questionnaires were analyzed that encompassed physicians at different level of training and students in the final year of their training, from five major tertiary care centres, located at Karachi and Hyderabad and who are involved in decision making about brain death and related issues. RESULTS: One hundred and forty one (54 percent) respondents did not have a clear idea regarding the definition of brain death. Majority of doctors 122 (47 percent) would therefore not turn off the ventilator even in a brain dead patient. Sixty seven (26 percent) actually considered it Euthanasia. Most considered 24 hrs as optimal period before confirming the diagnosis of brain death. Most of the doctors favoured a confirmatory test, like an electroencephalogram, to confirm the diagnosis of brain death. Majority of the doctors (68 percent) would not consider stopping ventilatory support of a patient in a persistent vegetative state. CONCLUSION: This study highlights the lack of understanding and confusion regarding issues surrounding brain death in this region especially among junior doctors and highlights the importance of including these issues in the medical curricula