Diagnosis of brain death in Brazil

Brain Death and Management of the Potential Donor

“…Even among countries with an organized diagnostic protocol, there is substantial variation in the criteria that are used [ 3 , 4 , 6 , 11 – 13 ]. The most significant differences between the criteria adopted in each country are the number of clinical examinations (ranging from one to three different examiners); intervals between exams (1–24 hours, for adults); mandatory complementary examination (being optional in several countries); preferential type of complementary test to be performed; and qualification of the doctor who performs the examinations (requirements in several countries are previous experience with the clinical tests, minimum time since graduation, and having some medical specialization) [ 3 , 14 – 16 ].…”

“…When the clinical examination is inconclusive, or the patient has any peculiarity, ancillary tests are required. In some countries, like Brazil, ancillary tests are mandatory by law [ 3 , 4 , 14 ].…”

“…It is the responsibility of the team involved in BD diagnosis to determine whether these abnormalities are secondary to the natural evolution to BD or a confounding variable that impairs the neurological examination. Severe hypernatremia refractory to treatment does not preclude BD determination, except when it is the only cause of the coma [ 3 , 4 , 14 – 16 ].…”

“…Severe exogenous intoxication, including those by CNSd (e.g., opioid analgesics and other sedatives) commonly used in the ICUs, needs to be ruled out. When CNSd are used in continuous infusion and habitual dosages, it will be necessary to wait for a minimum interval of four to five half-lives after the drug suspension before starting procedures for determining BD (Table 38.1 ) [ 14 , 16 ].…”

Analysis of brain death declaration process and its impact on organ donation in a reference trauma center

“…(6) In 2017, there was an update on Brazilian law regarding BD declaration (Decree 9,175, of October 18, 2017, and Federal Medical Council Resolution 2,173/17, of November 23, 2017) aiming to increase the number of successful organ donations (7,8) -Westphal et al, offer a comprehensive review about these changes. (9) A successful organ donation is associated with short times between first and second clinical examination for BD. (10) Reduction of BD intervals is probably a good strategy to increase the number of organs and tissues available for transplantation.…”