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Fulltext Therapeutic intervention scoring system in medical intensive care (letter)

Delilkan AE

Med J Malaysia, 1989 Dec;44(4):361-2.
PMID: 2520051

Comment on: Adam BA, Kin LC, Wahab AS. Therapeutic intervention scoring system in medical intensive care. Med J Malaysia. 1989 Jun;44(2):134-9

Matched MeSH terms: Brain Death/diagnosis*
Fulltext Healthcare System Impact on Deceased Organ Donation and Transplantation: A Comparison Between the Top 10 Organ Donor Countries With 4 Countries in Southeast Asia

Cowie S, Choy SH, Shah DM, Gomez MP, Yoong BK, Koong JK

Transpl Int, 2023;36:11233.
PMID: 37711402 DOI: 10.3389/ti.2023.11233

The need for organ donation is constantly increasing. Some countries have made improvements, while others, such as countries in Southeast Asia (SEA), have some of the lowest rates of deceased donors (pmp). This review aims to compare 14 countries with regards to many variables related to healthcare systems. Countries leading in deceased organ donation spend more on health and education, which is associated with increased potential for deceased organ donation. Out-of-pocket expenditure, is also associated with a decrease in deceased organ donation. Countries in SEA are lacking in healthcare resources such as workforce and materials, which are both necessary for a successful transplant program. Most countries in SEA have an excellent foundation for successful organ donation systems, including proper legislation, government support, and brain death laws along with an overall acceptance of brain death diagnosis. Priorities should include improving coordination, donor identification, and healthcare worker education. Countries in SEA have a lot of potential to increase deceased organ donation, especially by investing in healthcare and education. There is no one size fits all for organ donation programs and countries in SEA should focus on their strengths and take cultural differences into consideration when planning interventions.

Matched MeSH terms: Brain Death*
Fulltext Diagnosis and management of brain death

Namazie M

Med J Malaysia, 1980 Jun;34(4):363-7.
PMID: 7219264

The diagnosis and management of brain death is discussed in this paper. Criteria recommended by the Conference of Medical Royal Colleges and their Faculties in U.K. were used in the diagnosis of brain death. It is felt that brain death should be considered as death of the individual and a plea is made to draw up guidelines on management of patients with brain death.

Matched MeSH terms: Brain Death*
Fulltext Awareness, attitude and willingness regards cadaveric organ donation and awaness of brain death among Sarawakians in Kuching, Malaysia

Lim KG, Tan AS, Wong SC, Tee EG, Burud IA

Ceylon Med J, 2022 Nov 30;67(3):113-120.
PMID: 37933994 DOI: 10.4038/cmj.v67i3.9699
Matched MeSH terms: Brain Death*
Fulltext Family decision-making about organ donation: a systematic review

Makmor, T., Abdillah, N., NurulHuda, M.S., Raja Noriza, R.A., Roza Hazli, Z.

JUMMEC, 2015;18(1):1-4.
MyJurnal

The family is an important factor that influences an individual’s decision for organ donation. The number of studies addressing the family’s role in organ donation is limited. It is imperative to explore these studies and offer recommendations that may help in addressing organ shortage. 15 studies with more than 2100 participants were selected for a systematic review. The studies were accessed by searching three databases: MEDLINE, Elsevier, and PsycINFO. This systematic review indicates that knowledge about brain death and the circumstances surrounding organ donation and transplantation are the most important factors that affect a family’s decision regarding organ donation. Educational efforts targeting the family should be initiated, which can then guide the family’s decision on organ donation. We suggest that educational efforts be consistent with other factors such as religious beliefs that influence the family’s decision.

Matched MeSH terms: Brain Death
Fulltext Overlap of Bickerstaff brainstem encephalitis/Guillain-Barré syndrome simulating brain death

Tan CY, Ahmad SB, Goh KJ, Latif LA, Shahrizaila N

Neurol India, 2018 9 21;66(5):1475-1480.
PMID: 30233023 DOI: 10.4103/0028-3886.241342
Matched MeSH terms: Brain Death/diagnosis*; Brain Death/physiopathology
Fulltext Brain death and organ donation: a comparison of three influential groups of Muslim professionals

Makmor, T., Roza Hazli, Z., Khaled, T., NurulHuda, M.S., Nawi, A., Wan Ahmad Hafiz, W.M.A., et al.

JUMMEC, 2015;18(1):1-7.
MyJurnal

Organ transplantation is a new treatment for end-stage organ failure. However, the total number of transplants performed in Malaysia in 2012 was only 94. Rates of deceased and living donors in Malaysia for 2012 were chronically low (0.55 and 1.87 per million population, respectively). A sample of 350 respondents in mosques, hospitals, and universities in various places in the Klang Valley, Kelantan and Pahang were collected between October and December 2013 to investigate the level of knowledge of health care professionals (HCPs), religious leaders (RLs), and academics (ACAs) and their stand on two issues on brain death. The result on the first issue (procuring organs from brain dead donors for transplantation) revealed that 52.8%, 23.7%, and 23.4% of HCPs, RLs, and ACAs, respectively, were in support of it; 30.2%, 31.8%, and 45.2% were uncertain about it; and 17%, 44.5%, and 31.5% were against it. On the second issue (terminating the life support machine of a brain dead person), 60.4%, 35.7%, and 25% of HCPs, RLs, and ACAs, respectively, were in support of it; 26.4%, 36.4%, and 38.7% were uncertain about it; and 13.2%, 27.7%, and 36.3% were against it. The lack of knowledge on Islam brain death-related issues should be addressed by educational efforts targeting these three groups of professionals. Special emphasis should be paid to educating RLs as they can channel their knowledge and perception to the other groups and to the Muslim public.

Matched MeSH terms: Brain Death
Fulltext SMA Lecture: Ethical consequences of technological change

Rajakumar MK

Singapore Med J, 1984 Feb;25(1):1-5.
PMID: 6463657

Dr Rajakumar delivered this lecture at the 14th SMA National Medical Convention on 16.4.1983
Republished in: Republished in: Teng CL, Khoo EM, Ng CJ (editors). Family Medicine, Healthcare and Society: Essays by Dr M K Rajakumar, Second Edition. Kuala Lumpur: Academy of Family Physicians of Malaysia, 2019: 83-90

Matched MeSH terms: Brain Death
Fulltext The health care professional's attitudes towards brain death and cadaveric organ transplantation: the influence of cadaveric donor and transplantation programs--a Malaysian survey

Rozaidi SW, Sukro J, Dan A

Med J Malaysia, 2000 Dec;55(4):478-85.
PMID: 11221161

One of the main reasons for poor response in organ donation is the lack of positive attitudes and knowledge present in health care professionals. Definite legislation, policies and programmes dealing with brain death and cadaveric organ transplantation have shown some favourable results in terms of increasing donor rates. These programmes are mainly Western based; therefore adopting such programmes to be used locally may not be adequate or proper. To address this issue, we decided to carry out a questionnaire in two tertiary hospitals in Malaysia, one with a well establish brain death and cadaveric organ transplantation programme and one with none.

Matched MeSH terms: Brain Death*
Fulltext Brain death: rapid evaluation using computerized radionuclide cerebral flow study

Paramsothy M, Ong GSY, Wong BH, Loh TG, Delilkan AE

Med J Malaysia, 1986 Sep;41(3):189-97.
PMID: 2823083

Demonstration of arrested intracerebral blood flow is the ultimate evidence of brain death. Computerized radionuclide cerebral flow study was done on 18 patients diagnosed clinically as brain dead. Correlation was made with clinical neurophysiological and EEG findings. The criteria for diagnosis of arrested intracerebral perfusion using radionuclide flow study were: non-visualization of blood flow activity in the intracranial arteries during the arterial phase, diffused cerebral activity during the capillary phase and non-filling of venous sinuses during the venous phase; visualization of typical 'hot nasal' activity; the time activity curve over the cerebral hemispheres lacks a bolus effect and instead shows a delayed gradual rise of activity. These features are pathognomonic of brain tamponade.
Arrested intracranial circulation was seen in 16 patients (ten had electrocerebral silence; one had extremely abnormal EEG with small voltage activity and five had no EEG done). In the remaining two patients, some cerebral blood flow was demonstrated (one had no definite cerebral activity and the other had diffused EEG activity).
Radionuclide cerebral flow study is a very sensitive, accurate, safe, simple, rapid and non-invasive modality in confirming brain death and is especially useful in patients on "brain-protection" regime, in hypothermia or in certain metabolic states where diagnosis based on clinical and EEG criteria is difficult. EEG need not be a required procedure once brain death is established by the demonstration of arrested intracranial circulation.

Matched MeSH terms: Brain Death*
Clinical course and determination of brainstem death in a children's hospital

Goh AY, Mok Q

Acta Paediatr, 2004 Jan;93(1):47-52.
PMID: 14989439

AIM: To study the aetiology and clinical course of children with brainstem death in a paediatric intensive care unit (ICU) and to determine whether current the practices that are used to declare brainstem death conform to accepted criteria.
METHODS: A retrospective review chart of all patients with brainstem death (n = 31) admitted to the paediatric ICU between January 1995 and December 1998 was drawn up.
RESULTS: Mean age of the patients was 51.9 +/- 54.5 mo with the main diagnoses being head trauma in 11 children, anoxic encephalopathy in 7, brain tumour in 5, drowning in 4, CNS haemorrhage in 3 and CNS infection in 1 child; 32.3% of the children were given pre-ICU admission cardiopulmonary resuscitation. The average time from insult to suspected brainstem death was 27 h and suspected brainstem death to confirmation was 25 h, with an average of 1.6 examinations performed. EEG was done in 14 patients, with electrocerebral silence in 8 after the first examination and in a further 5 after repeat testing. Cerebral blood-flow scans were done in 3 children and evoked potentials in 1 child.
CONCLUSIONS: Trauma remains the most common primary diagnosis leading to brainstem death. Intensivists in this large hospital for children mainly conform to accepted guidelines for determination of brainstem death although there is a wider use of ancillary tests to aid diagnosis. The study also showed a low rate of < 10% of organ procurement for transplantation.

Study site: Paediatric ICU, Great Ormond Street Hospital, London, United Kingdom

Matched MeSH terms: Brain Death/physiopathology*
Fulltext Knowledge and attitudes of healthcare professionals and the impact on willingness to donate organs: a tertiary hospital survey

Oo WL, Ong JS, Fong JW, Hossain MM, Baskaran ND, Haron H, et al.

Singapore Med J, 2019 Jul 22.
PMID: 31328238 DOI: 10.11622/smedj.2019080

INTRODUCTION: Healthcare professionals (HCPs) working in critical care areas play an important role in the organ donation (OD) process. We studied HCPs' own willingness to be organ donors and its association with sociodemographic factors as well as their knowledge and attitudes about OD and transplantation.

METHODS: A cross-sectional survey of HCPs working in four critical care units in a major transplant centre in Malaysia was undertaken using a validated structured questionnaire. Responses were analysed using multivariable analysis with willingness to donate as the dependent variable.

RESULTS: Of the 412 respondents (response rate 98.1%), the majority were nurses (60.4%), Malay (71.1%) and female (77.2%). Overall, 68.0% were willing to donate. The independent predictors of willingness to donate were profession (p < 0.001) and the Hindu religion (p = 0.001). Ethnicity (p = 0.003), religious belief (p < 0.001), knowledge (p = 0.016), belief in brain death (p = 0.018) and confidence in transplantation (p < 0.001) also independently correlated with willingness to donate, while attitudes to OD did not. Of those willing to donate, only 37.3% were carrying a donor card and only 63.1% had informed their family of their intention to donate.

CONCLUSION: Although willingness to donate was higher in critical care HCPs than HCPs in general, significant knowledge gaps as well as certain beliefs and perceptions that could pose a barrier to OD were identified in this group. Measures to improve OD rates in Malaysia should include targeted educational programmes for HCPs working in critical care areas.

Matched MeSH terms: Brain Death
Islamic medical jurisprudence syllabus: A Review in Saudi Arabia

Chamsi-Pasha H, Albar MA

Med J Malaysia, 2017 10;72(5):278-281.
PMID: 29197882

INTRODUCTION: The ever-increasing technological advances of Western medicine have created new ethical issues awaiting answers and response. The use of genetic therapy, organ transplant, milk-banking, end-of-life care and euthanasia are of paramount importance to the medical students and need to be addressed.
METHODS: A series of searches were conducted of Medline databases published in English between January 2000 and January 2017 with the following keywords: medical ethics, syllabus, Islam, jurisprudence.
RESULTS: Islamic medical jurisprudence is gaining more attention in some medical schools. However, there is still lack of an organised syllabus in many medical colleges.
CONCLUSION: The outlines of a syllabus in Islamic medical jurisprudence including Islamic values and moral principles related to both the practice and research of medicine are explored.

Matched MeSH terms: Brain Death/legislation & jurisprudence
Knowledge, attitude and factors influencing public willingness towards organ donation among hospital patients and relatives in Negeri Sembilan, Malaysia

Ismail ASB, Lim KG, Mahadevan DT

Med J Malaysia, 2020 05;75(3):260-265.
PMID: 32467542

BACKGROUND: Malaysia continues to have a very low cadaveric organ donation rate of 0.48 per million population. The aim of this paper is to assess the attitude, beliefs and knowledge of patients and relatives at three different hospitals in Negeri Sembilan towards organ donation to increase the acceptability of organ transplant.
METHODS: A cross-sectional descriptive study with convenient sampling was carried out Hospital Tuanku Ja'afar, Hospital Port Dickson and Hospital Tuanku Ampuan Najihah in Negeri Sembilan, Malaysia. The participants answered a questionnaire regarding the source of their information about organ donation, their knowledge about brain death and willingness to donate. The association between variables was tested using chi-squared test or Fischer's exact test as appropriate.
RESULTS: A total of 385 individuals completed the survey of whom 134 (35%) were willing to donate their organs upon death and 25(19%) were registered donors. Higher educational level (41%), age 30 and below (42%) and people who attended organ donation awareness campaigns (60%) were more willing to donate their organs. Correct understanding of brain death was associated with willingness to be an organ donor. The commonest reason cited for unwillingness to donate was opposition from family members.
CONCLUSION: Marital status, religion, source of knowledge and occupation are significant factors in willingness to donate organs among Malaysians. Lower age and higher educational level were positive factors towards organ donation. Direct personal contact through awareness campaigns, family and friends has a potential for greater positive impact on organ donation.

Matched MeSH terms: Brain Death
Factors Influencing Attitude Toward Organ and Tissue Donation Among Patients in Primary Clinic, Sabah, Malaysia

Lim KJ, Cheng TTJ, Jeffree MS, Hayati F, Cheah PK, Nee KO, et al.

Transplant Proc, 2020 Apr;52(3):680-686.
PMID: 32146022 DOI: 10.1016/j.transproceed.2020.01.007

INTRODUCTION: Worldwide, the gap between organ supply and demand has widened over the years. Malaysia has one of the lowest deceased organ donation rates. Success rate of organ or tissue procurement depends on not only the approach rate by health care providers but also the awareness among the public, whereby it can be a platform for family initiation of organ donation. The purpose of this study is to assess the knowledge of and determine the factors influencing attitude toward organ and tissue donation among patients in a primary clinic.
METHODS: A cross-sectional analytical study was carried out. Self-administered questionnaires were given to 400 patients who registered at an outpatient clinic in April 2018. Convenience sampling was applied.
RESULTS: Monthly income, education level, occupation, and knowledge level are significantly associated with attitude of the respondents toward organ and tissue donation. Occupation influenced attitude toward organ donation. Knowledge of organ donation and brain death both significantly affected attitude toward organ donation.
CONCLUSION: The greater the knowledge of organ donation and brain death, the more positive impression or attitude toward organ donation. Education level and income are the main predictors that influence attitude toward organ donation. Hence, it is important for public health units to promote and deliver public education on organ donation, change public misconceptions, and work parallel with hospitals to increase organ donation rates in Sabah.

Matched MeSH terms: Brain Death

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