News Release

Diagnostic criteria for brain death vary worldwide

Peer-Reviewed Publication

American Academy of Neurology

ST. PAUL, Minn. – Since Harvard Medical School published its landmark criteria regarding clinical definition of “brain death” in 1968 (JAMA, 1968), diversity in these criteria has evolved worldwide. According to the first comprehensive survey of its kind, published in the January 2002 edition of Neurology, major differences in the procedures used to diagnose brain death in adults have been identified among the 80 countries that responded to the survey inquiries.

“Brain death,” the expression for irreversible loss of brain function, is declared when brain stem reflexes, motor responses, and respiratory drive are absent after careful exclusion of confounding factors. While there is uniform agreement on the neurological examination used to determine brain death, this survey found considerable differences in the number of required physicians, mandated level of experience and academic rank of physicians, in specialty preferences, and in recommendations of confirmatory tests. Other striking variations in procedures included observation time from first diagnosis and methods of apnea testing. “My objective was straightforward – to survey brain death criteria in adults throughout the world,” said study author Eelco Wijdicks, M.D., of the Department of Neurology, Mayo Medical Center, Rochester, Minn. Questions asked in the survey were:

1. What are the specific guidelines, mandatory qualifications of the physicians, number of physicians needed to declare brain death, time of observation and need for confirmatory laboratory tests?

2. Is there a legal provision of organ transplantation and brain death in your country? Of the 80 countries responding, European, South American, and Asiatic countries were well represented. Brain death guidelines or code of practice were present in 70 of the 80 countries; official legal standards on organ donation were present in 55 of the 80 countries.

According to Wijdicks, “At a philosophical level, some may argue that these differences could have resulted from dissatisfaction with the original concept, and could also reflect cultural attitudes.” This comparison of protocols mostly brings out differences in procedural matters, which could be a result of collective decisions by task forces. He notes that in many countries, the guidelines seem unnecessarily complicated. Wijdicks concludes with a recommendation that standardization should be considered.

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The American Academy of Neurology, an association of more than 17,500 neurologists and neuroscience professionals, is dedicated to improving patient care through education and research. For more information about the American Academy of Neurology, visit its web site at www.aan.com.

For more information contact: Kathy Stone, 651-695-2763; kstone@aan.com
For a copy of the study, contact Cheryl Alementi, 651-695-2737; calementi@aan.com


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