[Brain death criteria; guidelines by the Public Health Council]

The Committee on brain death criteria of the Health Council of the Netherlands has formulated guidelines for diagnosing brain death according to prevailing medical opinion. The guidelines are based on the relevant scientific literature and consultation of the professional groups involved and take into consideration that various views on death, or brain death, are existent in the community. The Committee has attempted to phrase the guidelines in clear and specific terms, in order to minimize interpretational differences. It endorses the most stringent definition of brain death, as given in the Organ Donation Act, the so-called 'whole brain death' concept. It must be established that the potential donor has irreparable and complete loss of brain and brain stem function. Three diagnostic phases are needed. In one of these an isoelectric electroencephalogram is required. This does not preclude that certain neurons in certain areas may still be active, but these phenomena are no indication of higher brain function or its intermediary or supportive functions. If electroencephalography cannot be performed, or if the apnoea test is not possible, cerebral arterial angiography is required. In children, the investigations must be repeated. A written codicil by the donor will be respected, but it is unlikely that organs or tissues are removed against the will of the family.