Second brain death examination may negatively affect organ donation
J.J.Egea-Guerrero, NeuroCritical Care Unit, Universitary Hospital Virgen del Rocio, Seville, Spain.juanjoegea@hotmail.com
Dr. Revuelto-Rey
Submitted May 10, 2011
We thank Lustbader et al. for their article. The authors reported longer observations periods than recommended and these periods also varied among different hospitals in the same city. It would also be interesting to compare observation periods among countries because clinical protocols for determination of brain death are not uniform around the world. [2] It is possible that the second examination may not always be necessary.
If all confounders are under control and the clinical criteria of brainstem death is met—with one ancillary test compatible with brain death— the diagnosis of "whole brain death" is certain.
In some circumstances, we accept an observation period between 6 and 24 hours. One well-conducted clinical examination for brain death for adults should be enough: Why suggest two? Why not do three? It is time to change our practices and improve our protocol according to this current evidence.
References
1. Lustbader D, O'Hara D, Wijdicks EF et al.Second brain death examination may negatively affect organ donation. Neurology 2010 Dec 15. (Ahead of print)
2. Wijdicks EF. Brain death worldwide: accepted fact but no global consensus in diagnostic criteria. Neurology 2002;58:20-25.
We thank Lustbader et al. for their article. The authors reported longer observations periods than recommended and these periods also varied among different hospitals in the same city. It would also be interesting to compare observation periods among countries because clinical protocols for determination of brain death are not uniform around the world. [2] It is possible that the second examination may not always be necessary.
If all confounders are under control and the clinical criteria of brainstem death is met—with one ancillary test compatible with brain death— the diagnosis of "whole brain death" is certain.
In some circumstances, we accept an observation period between 6 and 24 hours. One well-conducted clinical examination for brain death for adults should be enough: Why suggest two? Why not do three? It is time to change our practices and improve our protocol according to this current evidence.
References
1. Lustbader D, O'Hara D, Wijdicks EF et al.Second brain death examination may negatively affect organ donation. Neurology 2010 Dec 15. (Ahead of print)
2. Wijdicks EF. Brain death worldwide: accepted fact but no global consensus in diagnostic criteria. Neurology 2002;58:20-25.
Disclosure: The authors report no disclosures.