title: The implementation of a protocol promoting the safe practice of brain death determination.
abstract: OBJECTIVE
  The purpose of the study is to describe the implementation of measures introduced in Israel in 2009 to promote the safe practice of brain death determination (BDD).
  
  
  METHODS
  The measures require (1) physicians to undergo a mandatory training course, (2) the mandatory performance of an ancillary test, and (3) retrospective examination of all BDD forms by an independent committee. Any deviations from practice parameters were noted. Surveys were also undertaken to assess (i) the attitude of local physicians to the measures and (ii) whether similar measures are in place in Europe and whether they were considered necessary.
  
  
  RESULTS
  After implementation, the measures resulted in the absence of deviations from practice parameters over time. A majority of local physician (n = 64) felt the measures added a sense of security to BDD (73%) and ensured its proper performance (85%). The European survey (n = 20 countries) revealed (1) specialized BDD training is required in 60%, provided in 50%, while felt necessary by 80%; (2) independent supervision of BDD is performed in only one other country; and (3) BDD is performed country-wide using the same criteria in 80% while felt necessary by 95%.
  
  
  CONCLUSIONS
  The measures were successfully implemented, reduced diversity in patient testing, and positively accepted by local physicians. Wider application of the measures may be appropriate as suggested by the results of a European survey and the variability of BDD reported in the literature.
authors.affiliation: Department of General Intensive Care, Rabin Medical Center, Petah Tikva, 49100, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Israel Transplant Center, Tel Aviv, Israel. Electronic address: jonatanc@clalit.org.il.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Cohen
authors.affiliation: Departments of Pediatric Neurology and Medical Ethics, Shaare Zedek Medical Center, Jerusalem, Israel.
authors.forename: Avraham
authors.initials: A
authors.lastname: Steinberg
authors.affiliation: Department of General Intensive Care, Rabin Medical Center, Petah Tikva, 49100, Israel.
authors.forename: Pierre
authors.initials: P
authors.lastname: Singer
authors.affiliation: Israel Transplant Center, Tel Aviv, Israel.
authors.forename: Tamar
authors.initials: T
authors.lastname: Ashkenazi
mesh_terms: D000068:Accreditation; D026683:Advisory Committees; D001291:Attitude of Health Personnel; D001926:Brain Death / Q000175:diagnosis*; D005060:Europe; D019983:Guideline Adherence / Q000592:standards* / Q000706:statistics & numerical data; D019538:Health Care Surveys / Q000706:statistics & numerical data; D006801:Humans; D007557:Israel; D008505:Medical Staff, Hospital / Q000193:education*; D012189:Retrospective Studies; D012449:Safety
keywords: Accreditation; Ancillary testing; Brain death determination; Training