[Brain death determination algorithm].

Abstract

The article overviews the summarized published data concerning determination of brain death in different countries. The paper is based on some foreign guidelines, as well as recent literature. Brain death has been discussed extensively for the last 30 years. Brain death is defined as cessation and irreversibility of all brains function, including brain stem. Brain death is equivalent to death of the individual, even though the heart continues to beat and spinal cord functions may persist. There are no internationally accepted guidelines for diagnosis of brain death. Different sets of criteria, based on the Harvard Medical School criteria (1968), are used in different countries, and have been revised and updated in the recent years. The exact identification of the preconditions is among the most important requirements. The cause of coma has to be known and sufficient to account for the irreversible loss of all brain functions. Coma and apnea must coexist as well as absence of brainstem function. Cultural differences can lead to fundamentally different approaches to brain death determination. Moral, ethical, religious as well as educational factors, including mass media are important in the determination brain death in different countries. Brain death is both a medically and legally important event. In some Western countries, the legal and medical systems have cooperated, while in others only the medical system is working. There are no medical criteria and no legal support in Egypt, many Islamic and African countries. Brain death can usually be diagnosed reliably by clinical criteria alone. However, there are special circumstances when these are not suitable and cannot be applied and confirmatory instrumental test is required for the diagnosis of brain death. In the paper is presented algorithm of the brain death determination developed according to the some foreign guidelines, as well as literature.