Quality assurance in determinations of brain death

A 2002 study (Wang et al.) revealed the need to increase quality assurance (QA) activities to improve the declaration and documentation of brain death, thus improving the opportunity and potential for organ and tissue donation. One aspect of the QA concept is to provide checklists and training to physicians and hospital staff involved. Training will ensure that all personnel are sensitive to the complex process of brain death and the many diverse issues prevalent today. Checklists may be used to exclude other conditions or causes of irreversible coma and to verify the lack of appropriate reflexes in such patients. Electroneurodiagnostic (END) technologists may be asked to perform confirmatory tests in cases of suspected brain death, such as the EEG for electrocerebral inactivity (ECI), or the brainstem auditory or somatosensory evoked potentials. A look at published Guidelines will help ensure that END technologists perform these tests correctly. A solid understanding of the process ensures that diagnostic and technical mistakes are avoided and may provide helpful guidance to all involved. This paper also includes a brief look at some other available confirmatory tests, as well as some of the ethical issues involved.