title: Brain death determination: the imperative for policy and legal initiatives in Sub-Saharan Africa.
abstract: The concept of brain death (BD), defined as irreversible loss of function of the brain including the brainstem, is accepted in the medical literature and in legislative policy worldwide. However, in most of Sub-Saharan Africa (SSA) there are no legal guidelines regarding BD. Hypothetical scenarios based on our collective experience are presented which underscore the consequences of the absence of BD policies in resource-limited countries (RLCs). Barriers to the development of BD laws exist in an RLC such as Kenya. Cultural, ethnic, and religious diversity creates a complex perspective about death challenging the development of uniform guidelines for BD. The history of the medical legal process in the USA provides a potential way forward. Uniform guidelines for legislation at the state level included special consideration for ethnic or religious preferences in specific states. In SSA, medical and social consensus on the definition of BD is a prerequisite for the development BD legislation. Legislative policy will (1) limit prolonged and futile interventions; (2) mitigate the suffering of families; (3) standardise clinical practice; and (4) facilitate better allocation of scarce critical care resources in RLCs. There is a clear-cut need for these policies, and previous successful policies can serve to guide these efforts.
authors.affiliation: a Department of Anaesthesia and Intensive Care , Moi Teaching and Referral Hospital (MTRH) , Eldoret , Kenya.
authors.forename: Wangari
authors.initials: W
authors.lastname: Waweru-Siika
authors.affiliation: b Department of Internal Medicine, Division of Infectious Diseases , Duke University School of Medicine , Durham , NC , USA.
authors.forename: Meredith Edwards
authors.initials: ME
authors.lastname: Clement
authors.affiliation: a Department of Anaesthesia and Intensive Care , Moi Teaching and Referral Hospital (MTRH) , Eldoret , Kenya.
authors.forename: Lilian
authors.initials: L
authors.lastname: Lukoko
authors.affiliation: c St Mary's Hospital and Imperial College , London , UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Nadel
authors.affiliation: d Trent Center for Bioethics, Humanities and History of Medicine , Duke University Medical Center , Durham , NC , USA.
authors.forename: Philip M
authors.initials: PM
authors.lastname: Rosoff
authors.affiliation: e Department of Behavioral Sciences , Moi University , Eldoret , Kenya.
authors.forename: Violet
authors.initials: V
authors.lastname: Naanyu
authors.affiliation: f Division of Pulmonary and Critical Care Medicine Department of Internal Medicine , Duke University School of Medicine , Durham , NC , USA.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Kussin
mesh_terms: D017954:Africa South of the Sahara; D001926:Brain Death / Q000175:diagnosis*; D003657:Decision Making; D017408:Guidelines as Topic; D006291:Health Policy / Q000331:legislation & jurisprudence*; D006801:Humans; D007630:Kenya
keywords: Brain death; Sub-Saharan Africa; developing countries; health policy; irreversible coma