Vietnam's brain death diagnosis process, based on the 2007 Law on Human Tissue and Organ Donation, Transplantation, and Body Donation, draws upon international models. After nearly 20 years, the Ministry of Health is collaborating with other agencies to amend the law, aiming to streamline procedures and increase organ donation rates to benefit patients awaiting transplants.

Brain death, legally defined as the irreversible cessation of all brain function due to severe damage, is the legal basis for organ retrieval from registered donors. This determination requires at least three diagnoses, each adhering to strict clinical standards and conducted by an independent medical council.

Appointed by the head of the medical facility, the council comprises three specialists in critical care, neurology, neurosurgery, or forensic medicine. To ensure impartiality, doctors involved in the transplant surgery or the deceased's treatment are excluded.

Brain death determination takes a minimum of 12 hours from the onset of clinical indicators without signs of recovery. The diagnosis is only performed in facilities equipped with critical care units, ventilators, blood gas analyzers, and other necessary equipment.

The clinical criteria for brain death include: a deep coma (Glasgow Coma Scale score of 3); dilated pupils (over 4 mm) unresponsive to light; absence of corneal and cough reflexes; absence of oculocephalic reflex; lack of eye movement after cold water caloric testing; and apnea after ventilator removal. Furthermore, at least one ancillary test is required, such as an electroencephalogram (EEG), brain CT scan, transcranial Doppler ultrasound, cerebral angiography, or radionuclide imaging.

According to Dr. Du Thi Ngoc Thu from Cho Ray Hospital's Organ Transplantation Coordination Unit, organ donation, whether from living donors, those declared brain-dead, or those who have experienced circulatory death (cardiac arrest), is a humanitarian act, providing life-saving organs for patients with end-stage organ failure. As human organs are the only current source, strict legal requirements are essential.

Globally, brain death determination varies, but most countries prohibit the treating physician from declaring brain or circulatory death. No individual can interfere with resuscitation or treatment efforts.

Coordinators, responsible for overseeing the death assessment and potential organ donation, must be independent of the transplant surgeons and physicians treating pre- and post-transplant patients. Transparency and fairness in donor selection and organ allocation are paramount.

"Regulations prohibiting the diagnostic council's involvement with transplant surgeons or treating physicians prevent potential conflicts of interest and ensure that brain death diagnoses aren't made for personal gain," Dr. Thu explained.

Medical professionals retrieving organs from a brain-dead donor at Cho Ray Hospital. Photo courtesy of Cho Ray Hospital

Medical professionals retrieving organs from a brain-dead donor at Cho Ray Hospital. Photo courtesy of Cho Ray Hospital

Currently, Vietnamese law addresses organ donation from living or brain-dead donors, but not circulatory death. Dr. Thu noted that given the organ shortage, many countries are exploring circulatory death donation (donation after cardiac death). Clear legal provisions are crucial for implementing this type of donation.

From 2013 to 2016, the Ministry of Science and Technology commissioned Cho Ray Hospital to research kidney transplants from circulatory death donors. This research will inform the Ministry of Health in developing regulations for this type of organ donation.

Expanding organ donation programs, whether from brain-dead or circulatory death donors, offers numerous benefits for patients, families, and society. Transplant recipients experience improved quality of life, returning to work or school and contributing to society. Post-transplant treatment costs are one-third to one-fifth of pre-transplant costs, reducing healthcare expenditures and insurance burdens. Increased household income results from both the patient and family members returning to work.

"A well-developed, transparent, and equitable organ donation program also reduces illegal organ trafficking, contributing to social stability," Dr. Thu emphasized.

Le Phuong