European brain death codes: a comparison of national guidelines

Abstract

The majority of European countries have published recommendations for the diagnosis of brain death as a necessary prerequisite for organ donation. The concept of brain death as defining the death of the individual is accepted in all European countries; however, the guidelines for determining the total and irreversible loss of all brain functions differ somewhat in the various countries. While the clinical examination and documentation of the clinical signs of brain death are very uniform, there are significant differences in the guidelines for using technical confirmatory tests to corroborate the clinical signs. These range from rejecting all technical tests to accepting of multiple neurophysiological tests alone or in combination. The present study examined the similarities and differences in current concepts of brain death in the various European countries and their recommendations for the diagnosis of brain death. The diagnosis of brain death is based on a number of prerequisites, on the clinical diagnosis of deep coma, loss of all brainstem reflexes, and the demonstration of apnea. Neurophysiological tests are recommended by a number of national professional societies as confirmatory tests to confirm the clinical diagnosis of brain death and shorten otherwise necessary waiting periods of 6-12 h. Most brain death codes allow the use of electroencephalography, which must demonstrate electrocortical silence over a certain period. Evoked cerebral potentials can demonstrate the successive loss of activity of various afferent pathways and are accepted in some countries as a confirmatory test. Other neurophysiological tests which demonstrate the loss of cerebral perfusion can be implemented. Brain scintigraphy can confirm the loss of isotope uptake into the brain. Doppler sonography also demonstrates cessation of brain perfusion. Cerebral panangiography may also be used to demonstrate the loss of brain perfusion but is less desirable since it might endanger the patient.

Morte encefálica: uma discussão encerrada?

“…Based on various philosophical principles, these parameters stipulate variable intervals between clinical trials, various assignments of the professionals in charge of carrying out such tests and whether or not the execution of additional procedures are necessary 5 . A certain uneasiness is still frequent among the professionals involved, especially among critical care physicians, at the time of suspension of life support or at the time of filling in the death certificate 6,7 .…”

“…The basic issue is that the diagnosis of brain death can actually be only a prognosis of irreversibility which is arbitrarily set in a period preceding the biological death and extending in a spectrum that ranges from simple completion of a clinical examination consistent with brain death , as in Finland, until the completion of three clinical tests over a period of 24 hours, together with further examination, as it happens in Greece 5,25 . Therefore, to describe the same situation, this range goes from the simple acceptance of brainstem death as a diagnosis of brain death and therefore the death of the organism, to the demand of the death of the brain as a whole 5 .…”

“…Therefore, to describe the same situation, this range goes from the simple acceptance of brainstem death as a diagnosis of brain death and therefore the death of the organism, to the demand of the death of the brain as a whole 5 .…”

A brain death: concepts and confusions among medical experts, legal authorities and general public in Sri Lanka

“…The concept of whole brain death as definition of death of the individual is accepted in majority of European countries, while the clinical examination and documentation of the clinical signs of brain death are very uniform, there are significant differences in the guidelines for using technical confirmatory tests to corroborate the clinical signs 12 . The definition of death in Sri Lanka is given in the Transplantation Act No.…”

Persistent cerebral blood flow by transcranial Doppler ultrasonography in an asphyxiated newborn meeting brain death diagnosis: case report and review of the literature

“…Diagnosis of this condition is sometimes problematic due to clinical and technical factors as long as its immediate implications given that brain death has been recognized by scientific community and for legal requirements as an equivalent to the death of the individual. 1,2 Brain death diagnosis criteria in newborns are not well defined, in part because of the greater complexity of neurological exam in these patients. For a correct diagnosis, neurological exams should be performed by an experienced physician and supported by a variety of complementary exams.…”