[Consultation with the neurologist in transplantation medicine]

The neurological committee in the transplantational team not only has got to determine the exact physical point of death but also has to integrate the whole environment especially in having precise talks with intensive care staff and relatives. This procedure requires knowledge in law as well as tact and a specific medical training in this sort of conversations. The 3 major issues for determining the point of death should remain together as they used to, i.e. clinic plus zero wave EEG plus angiography. This fact is stressed by 12% of patients being "problematic cases" within a number of 50 patients who have been seen by us and considered for transplantation. In those 12% there were discrepancies in the 3 major criterias. Therefore we are not confirmed with today's tendency in which mere angiography suffices as criteria of the point of death. The above all existing ethical principle which permits to take away organs only after the death of the brain may not be confused with an unfavourable prognosis. The inclining need of organs for transplantations should not be prevented through a time spending and exact determination of the point of death. Better and ubiquitous organisation of transplantational teams is required - although exact criterias got to be obeyed - in order not to lose precious organs, which can still happen in hospitals, whereas patients in need of transplantation painfully await them respectively still die without them. In this complexity the neurological cooperation in the transplantational committee is an activity which requires high skills, time and exactness but, despite all effort offers satisfying and meaningful work.