21 May 2009
Reversal to whole brain death criteria after 15 years long experience with brain stem death criteria in PolandR Bohatyrewicz, M Zukowski, A Bohatyrewicz, E Marzec-Lewenstein, J Biernawska, J Sołek-Pastuszka, T Sulikowski, J Sienko
Ann Transplant 2009; 14(1): 78-78 :: ID: 880488
Polish brain death criteria, similar to the original Harvard ones, were published in 1984. In 1990, following British regulations, they were converted to the brainstem death criteria and revised twice, in 1994 and 1996. Brain death diagnosis basing solely on the clinical brain stem death criteria, without recommendation for any confirmatory tests, is currently used only in United Kingdom. Unfortunately, these criteria may proof inadequate in case of a complicated clinical situation such as intoxication, metabolic alterations, major facial injury, infratentorial lesions or cervical spinal cord injury etc. New Polish Transplant Act, passed by Polish Parliament in 2005, recommended return to the whole brain death concept for a diagnosis of brain death. In 2007, Polish Ministry of Health's Commission outlined new Polish brain death criteria. Optional use of instrumental confirmatory tests was implemented in new Polish national code of practice for the brain death diagnosis among adults. In children, up to two years old, instrumental tests are obligatory. Poland is the first country, which reversed national guidelines from brain stem death to the whole brain death concept. Initially, there were some problems concerning understanding of new, a little more complicated classification of primary and secondary brain injuries, infratentorial and supratentorial processes, as well as slightly modified apnoe test. Commentary, answering the most frequent questions was published in Anesthesiology and Intensive Therapy - Official Journal of Polish Society of Anaesthesiology and Intensive Therapy. This publication terminated majority of problems appearing after implementation of new instructions for brain death diagnosis.
Keywords: Organ Procurement
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