title: Polish Guidelines on Diagnosing Brain Death in Adults vs the International Perspective: Are We in Need of an Update?
abstract: BACKGROUND
  The Polish definition of brain death originated from the original Harvard criteria and has been revised several times. Practitioners worldwide are required to regularly update their national guidelines on the definition of brain death to fit the latest international research concerning this topic.
  
  
  OBJECTIVE
  (1) Compare current Polish guidelines on diagnosing brain death in adults with the American, British, Australian, and New Zealand recommendations; and (2) evaluate existing differences for the purposes of updating the Polish guidelines.
  
  
  METHODS
  Current guidelines on diagnosing brain death published by The American Academy of Neurology (USA, 2010), the Academy of Medical Royal Colleges (United Kingdom, 2008), the Australian and New Zealand Intensive Care Society (AU/NZ, 2013), and the Polish Ministry of Health (Poland, 2007).
  
  
  RESULTS
  All guidelines outline similar recommendations regarding the need for a suitable observation period before clinical examination and for basic medical conditions and exclusions to be evaluated before testing, the obligatory role of clinical examination including brain stem reflexes and apnea testing, and the nonobligatory role of ancillary tests. There is no consensus regarding: the recommended time period of pretesting observation, the number, seniority, and specialty of clinicians performing the testing, the role of additional exclusion criteria, the repeatability of clinical tests, the methodology of apnea testing, and recommended confirmatory tests.
  
  
  CONCLUSIONS
  Current Polish guidelines on diagnosing brain death in adults remain up-to-date in comparison to the guidelines analyzed, though additional recommendations concerning apnea testing, drug and toxin clearance, and medical exclusion criteria for potential brain dead patients might be considered an important point of interest in the future.
authors: Brothers Hospitallers' of St. John of God Hospital, Department of Angiology, Internal and Geriatric Medicine, Kraków, Poland. Electronic address: ewelina.ag.nowak@gmail.com.
authors: E
authors: E
authors: Nowak
authors: Jagiellonian University, Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Kraków, Poland.
authors: R
authors: R
authors: Pfitzner
authors: First Chair of General Surgery, Jagiellonian University Medical College, Kraków, Poland and The Silesian Center for Heart Diseases, Zabrze, Poland.
authors: P
authors: P
authors: Przybyłowski
mesh_terms: D000328:Adult; D001315:Australia; D001926:Brain Death / Q000175:diagnosis*; D006801:Humans; D038622:Internationality; D009520:New Zealand; D011044:Poland; D017410:Practice Guidelines as Topic; D006113:United Kingdom