[Brain death in Ibero-America].
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.


METHODS
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 In some countries, when organs are not donated for transplant, support measures are not withdrawn, this being more frequent in children.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.
Escudero
D
D
Servicio de Medicina Intensiva y Coordinación de Trasplantes, Hospital Universitario Central de Asturias, Oviedo, España. dolores.escudero@sespa.princast.es
Matesanz
R
R
Soratti
C A
CA
Flores
José Ignacio
JI
D000328:Adult; D001285:Atropine; D001831:Body Temperature; D001926:Brain Death / Q000175:diagnosis* / Q000331:legislation & jurisprudence; D001944:Breath Tests; D002245:Carbon Dioxide / Q000032:analysis; D002648:Child; D003625:Data Collection; D003955:Diagnostic Tests, Routine; D006801:Humans; D007390:International Agencies / Q000458:organization & administration* / Q000592:standards; D007843:Latin America; D009460:Neurologic Examination; D011174:Portugal; D017410:Practice Guidelines as Topic; D013030:Spain; D020458:Third-Party Consent; D009927:Tissue and Organ Procurement / Q000331:legislation & jurisprudence / Q000458:organization & administration* / Q000592:standards; D028761:Withholding Treatment / Q000331:legislation & jurisprudence
D002245:Carbon Dioxide; D001285:Atropine