D Escudero1, R Matesanz, C A Soratti, José Ignacio Flores. 1. Servicio de Medicina Intensiva y Coordinación de Trasplantes, Hospital Universitario Central de Asturias, Oviedo, España. dolores.escudero@sespa.princast.es
Abstract
OBJECTIVE: To examine the diagnosis of brain death (BD) in Latin America. BACKGROUND: The term BD has long been used to define the death of an individual despite legal differences and variations in the diagnostic criteria applied in each country. METHOD: A survey was conducted to gain information on the medical and legal diagnosis of BD in the 21 countries that make up the Latin American Network/Council of Donation and Transplant. RESULTS: All the Latin American countries except for Nicaragua legally recognize BD as the death of the person. To declare a person dead, 2 or 3 doctors are required in most countries. In all the countries, the requirements that must be fulfilled are unresponsive coma, lack of brainstem reflexes and of spontaneous breathing. Partial pressure of arterial carbon dioxide levels required in the apnea test vary from 50-60mm Hg. The minimum temperature required for a neurological examination ranges from 32 degrees -35 degrees C. The atropine test is mandatory in 7 (35%) countries. The most recommended observation period is 6h, but there is great variation and can be up to 24h. In 8 countries (40%), an instrumental test is obligatory, while in the remaining countries this is only undertaken under special circumstances. In some countries, when organs are not donated for transplant, support measures are not withdrawn, this being more frequent in children. CONCLUSIONS: There seems to be some uniformity in the main diagnostic criteria applied, with differences observed in clinical prerequisites, neurological exams, observation time, instrumental tests and the clinical decisions made following a declaration of BD. It is recommended that diagnostic criteria be standardized.
OBJECTIVE: To examine the diagnosis of brain death (BD) in Latin America. BACKGROUND: The term BD has long been used to define the death of an individual despite legal differences and variations in the diagnostic criteria applied in each country. METHOD: A survey was conducted to gain information on the medical and legal diagnosis of BD in the 21 countries that make up the Latin American Network/Council of Donation and Transplant. RESULTS: All the Latin American countries except for Nicaragua legally recognize BD as the death of the person. To declare a person dead, 2 or 3 doctors are required in most countries. In all the countries, the requirements that must be fulfilled are unresponsive coma, lack of brainstem reflexes and of spontaneous breathing. Partial pressure of arterial carbon dioxide levels required in the apnea test vary from 50-60mm Hg. The minimum temperature required for a neurological examination ranges from 32 degrees -35 degrees C. The atropine test is mandatory in 7 (35%) countries. The most recommended observation period is 6h, but there is great variation and can be up to 24h. In 8 countries (40%), an instrumental test is obligatory, while in the remaining countries this is only undertaken under special circumstances. In some countries, when organs are not donated for transplant, support measures are not withdrawn, this being more frequent in children. CONCLUSIONS: There seems to be some uniformity in the main diagnostic criteria applied, with differences observed in clinical prerequisites, neurological exams, observation time, instrumental tests and the clinical decisions made following a declaration of BD. It is recommended that diagnostic criteria be standardized.