[Brain death and organ procurement: a specific context].

Abstract

Brain death is defined as an irreversible damage to the brain stem associated with lesions of the hemispheres. It determines the irremediable destruction of the whole body which occurs within a short delay. Brain death diagnosis is identified from a series of neurological criteria, i.e.: the loss of consciousness, the disappearance of brainstem reflexes, the lack of spontaneous breathing movements. Legal considerations in use in France imply that brain death must be confirmed by two isoelectric encephalographs or by the absence of cerebral perfusion on cerebral arteriography. The diagnosis must be established by two practitioners who are not involved in transplantation activity. Prexisting cardiac activity and organ perfusion allow indeed organs and tissue procurement for transplantation. Organ procurement is supported by intensive care of the brain dead patient aiming to correct hemodynamic, ventilatory and metabolic disorders related to brain death. Organ donation implies that one would know the patient's will which would have been clearly expressed during his lifetime. Organ harvesting is organized according to guidelines for local practice and regional and national allocation. In consideration of transplantation requirements there is a persisting organ shortage for several years. Efforts must be directed toward an improvement in brain dead patients identification and management.