The clinical criteria of brain death throughout the world: why has it come to this?

Wijdicks, Eelco F. M.

doi:10.1007/bf03021842

Cited by 20 publications

(14 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Shorter time intervals between BD examinations, as compared to published recommendations, have been reported by others (12,13,25). The need for a second BD examination for adult patients has been questioned (2,7,18,21). Although it is controversial whether delayed diagnosis affects organ viability (26), a recent retrospective study found that a longer BD examination interval was associated with lower organ donation consent rates, some interval donor loss due to cardiac arrest, and possibly increased hospital costs (27).…”

Section: Discussionmentioning

confidence: 88%

“…Concerning findings included the number of children who had only one BD examination (19%), and no (18%) or only one (36%) apnea test, many of whom went on to become organ donors or who were pronounced dead by BD criteria without any ancillary testing. The fundamental components of a BD examination are clinical, with coma, apnea, and absent brainstem reflexes (1,(15)(16)(17)(18)(19); the absence of respiratory drive is therefore essential for the clinical determination of BD (21). Ancillary tests are not required unless there is a reason a full clinical examination cannot be completed, or there may be confounders of the clinical examination (Table 1).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Brain Death in Canadian PICUs

Joffe

Shemie²,

Farrell³

et al. 2013

Pediatric Critical Care Medicine

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Brain Death in Canadian PICUs

Joffe

Shemie²,

Farrell³

et al. 2013

Pediatric Critical Care Medicine

View full text Add to dashboard Cite

show abstract

“…A finding that pituitary function is preserved to some extent does not rule out the diagnosis of ILBF (15); 4. There is as yet no worldwide, uniform standard for the diagnosis of ILBF (16)(17)(18)(19)(20)(21), and in Germany, for example, the relevant guidelines continue to be revised (1). As to concerns 1 and 2: Clinical manifestations of loss of brain function that have been ascertained in accordance with the guidelines indicate loss of function of the brainstem and therefore also of the pathways connecting the cerebellum and cerebrum to other parts of the central nervous system.…”

Section: Remarks On Specific Methodological Concernsmentioning

confidence: 99%

The Relevance of Irreversible Loss of Brain Function as a Reliable Sign of Death

Brandt¹,

Angstwurm²

2018

Deutsches Ärzteblatt International

View full text Add to dashboard Cite

he diagnosis of irreversible loss of brain function (ILBF) means that the patient's brain has irretrievably ceased to function despite the ongoing maintenance of cardiovascular function by the methods of intensive care medicine (Box 1). In §3 of the German Transplantation Law (Transplantationsgesetz, TPG), ILBF is described as "the final, irreversible loss of all function of the cerebrum, cerebellum, and brainstem." The significance of ILBF as a reliable sign of death has been definitively established in Germany (as in other countries) in position statements of multiple involved organizations, including the German Medical Association (Bundesärztekammer) (Box 2), medicalscientific specialty societies, and religious communities (2-8). The basic elements of the determination of ILBF have not changed, and the position statements concerning them are still applicable. The present article, Summary Background: There is an ongoing need for clear explanation of the diagnostic entity called "irreversible loss of brain function" (ILBF), as the absolute reliability of this diagnosis and its significance continue to be widely misunderstood. The determination of death as an objective medical-scientific matter is often not clearly distinguished from various other aspects of death, such as its metaphysical and cultural aspects and the ways in which the living deal with the dead. Method: This review is based on articles retrieved by a selective literature search in the PubMed database and on guidelines and standardized diagnostic protocols from Germany and abroad. Results: ILBF can be caused by brain ischemia or anoxia or by any other type of brain disease or injury leading to an elevation of the intracranial pressure above the blood pressure and thereby to an arrest of the cerebral circulation. All situations in which brain function is merely reduced but not abolished, or only temporarily but not permanently abolished, can be clearly differentiated from ILBF through the use of standard diagnostic procedures as recommended in the relevant guidelines. Biological features that are common to all human beings underlie the medical criteria for the determination of death. The most important elements of the determination of death are irreversibility of the loss of brain function, loss of integration of bodily functions into a single living being, and loss of ability for any self-reflection or any independent interaction with the environment. Conclusion: ILBF is a reliable sign that a human being is dead. There has never been even one known case of incorrect determination of ILBF after proper application of the standardized diagnostic procedures that are set down in the guideline according to §16 of the German Transplantation Law.

show abstract

“…An ideal confirmatory test should be safe, accurate, and inexpensive [23]. Confirmatory investigations generally fall into two general categories.…”

Section: Confirmatory Testsmentioning

confidence: 99%