Methods Used to Determine Brain Death Diagnosis Among Actual Organ Donors in Spain


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Abstract

The Spanish law defines diagnosis of brain death like the process to confirm the irreversible cessation of all functions of the entire brain, including the brainstem.ObjectiveTo describe the methods used for the diagnosis of brain death (BD) among actual deceased organ donors from 2001 to 2017, globally and according to some selected factors (type of hospital – with or without neurosurgery- and age group) and to know the evolution of those methods across the study period.MethodologyData source: National Registry for organ donation and transplantation Inclusion criteria and study period: All actual deceased organ donors between 2001 and 2017. Statistics: Descriptive analysis using SPSS v15.0.ResultsDuring the year 2017 clinical neurological evaluation (CNE) was the only method used for BD diagnosis in 12.6% of donors in which information is available. At least an ancillary test was used in the other 87.4%.The most frequent combination was CNE plus Electroencephalography (58.6%), followed by CNE plus Transcranial Doppler Ultrasonography (20.6%). The application of TC Doppler has increased across the study period.Among paediatric organ donors, CNE plus Electroencephalography are also the most frequent methods applied (50% for year 2017). CNE was the only method applied in 20% of paediatric group, followed by CNE + TC Doppler (15%) and CNE + Cerebral scintigraphy (15%).According type of hospital (with or without Neurosurgey), combination of CNE and Electroencephalography was once again the most frequently applied (58,3 % vs 59,7%), followed by CNE + TC Doppler (20,1% vs 22,6%) and CNE alone (11,8% vs 15,5%).ConclusionDiagnosis of BD entails important medical, ethical and legal implication in donation process. The methods used for diagnosis have kept some patterns across the study period. We have observed stability in the proportion of cases in which clinical neurological examination is used alone or in combination with electroencephalography. The application of Transcranial Doppler Ultrasonography and cerebral scintigraphy has increased over the time.

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