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Variability in brain death determination in europe: looking for a solution
Giuseppe Citerio1, Ilaria Alice Crippa, Alfio Bronco
1NeuroIntensive Care Unit, Department of Anesthesia and Critical Care, Ospedale San Gerardo, Via Pergolesi 33, 20900, Monza, Italy, g.citerio@hsgerardo.org.
Neurocritical Care
|May 29, 2014
Summary
European countries have varying criteria for determining brain death (BD), despite national guidelines. This practice variation highlights the urgent need for an international consensus on BD diagnosis to ensure consistent patient care.
Area of Science:
- Neurology
- Medical Ethics
- Public Health
Background:
- Brain death (BD) determination criteria differ significantly across European nations.
- Existing national laws or guidelines aim to standardize BD diagnosis within countries.
Purpose of the Study:
- To investigate and compare the procedures used to determine brain death across various European countries.
- To identify variations in clinical examination protocols, confirmatory testing, and cerebral blood flow assessment.
Main Methods:
- A web-based questionnaire was distributed to representatives from 33 European countries.
- Responses from 28 countries were analyzed, with follow-up for clarification.
Main Results:
- All countries utilize laws or national guidance for BD diagnosis, with mandatory clinical criteria including coma, apnea, and absent reflexes.
- Significant variations exist in the number of clinical examinations, observation times, and indications for confirmatory tests.
- Cerebral blood flow (CBF) assessment methods, such as conventional angiography and transcranial Doppler, are employed with differing frequencies.
Conclusions:
- While national standards exist, substantial disparities in brain death determination practices persist among European countries.
- An international consensus is crucial to harmonize BD diagnostic procedures and improve consistency in clinical practice.
