Criteria of brain death and removal of cadaveric organs

Several countries have formulated and accepted their own criteria for brain death but Finland was the first country in which brain death was legally accepted. The diagnosis is based on careful history taking, clinical examination, and confirmatory investigations when needed. The cause of the brain death must be fully established and there should be no doubt that the patient's condition is due to irreversible structural brain damage. Cerebral unresponsiveness, absence of brainstem reflexes, and absolute apnoea must be confirmed clinically. Confirmatory investigations are mandatory when the diagnosis of brain death remains in doubt. The two most important investigations are electroencephalography (EEG) and aortic arch angiography. The value of the EEG is limited by technical inadequacies and observer errors while angiography appears to be less prone to misinterpretation. The tests should be repeated when necessary, an an observation period may be required. The concept of brain death has developed together with advancing intensive care techniques and their wide availability in civilized nations. In general, the concept of brain death has gained wide support and has had a positive influence on the practice of transplant surgery. The physician in charge of a dying patient, however, should only consider what is best for the patient and his family and give no priority to transplant surgeons and their patients. The ethical aspects of brain death, including the feelings of the donor (donor card), recipient and intensive care staff, should always be kept in mind.