gms | German Medical Science

History: Up until now, relevant authors inaccurately claim that the concept of brain death was invented in Boston 1968 for the single purpose to harvest organs. It needs to be clarified that the concept of brain death has evolved in Europe between August 27^th, 1952 (Björn Ibsen’s day) and March 11^th, 1960 (Pierre Wertheimer’s day) entirely unrelated to the harvesting of organs for transplantation. In his speech on November 24^th, 1957, pope Pius XII accepted the termination of intensive care treatment under the condition, that “the soul has left the body”.

Status quo in Germany: The author has determined brain death 442 times since 1987. - Since July 2015 thecurrent “Richtlinie der Bundesärztekammer” is valid - including some changes in correlation to the preceeding “Richtlinie” (1998). In consequence, it could be varified for 2015/6, that 52% of all German “Entnahmekrankenhäuser” (n=1261) cannot determine brain death by members of their own staff because either a neurosurgeon and/or an neurologist is lacking. - The exact follow up of diagnostic steps is sometimes unclear (eg. accidental finding of cerebrovascular stand-still before clinical examination: is in that case a second proof of cerebrovascular stand-still necessary?) -There are different postulates for blood-pressure according to the procedures (clinical examination: “no shock” and systolic value; CTA and DSA > 80 mm Hg mean; transcranial Doppler/Duplex: > 60 mm Hg mean; cerebral perfusion scintigraphy: without value). – The postulates for CTA in the “Richtlinien” do not exactly correspond to the referenced publication of Welschehold et al, and sometimes get in contrast to results of classical angiography (cf. Kautzky, Zülch et al 1976, vs. CTA type of “stasis filling”, that systematically generates false negative results ) – Basic problems with the obligatory sheets (blue color hinders fax copy; missing patient identification on pate 2) have already been solved by a proposal of the Deutsche Stiftung Organtransplantation (DSO). – No publication has been found to validate the given lower limit of paCO2 (35mm Hg) before starting an apnoe-test.

Conclusion and Outlook: “Brain death” (“Hirntod”) is the surest medical diagnosis, if the respective “Entscheidungshilfen” / “Richtlinien” have been applied since 1982/1998. No false positive or negative result of this diagnosis has become known until now. – Nevertheless there is urgent need for an update of the current “Richtlinie” concering procedural, redactional and a few conceptional items. – In addition, the personal proceeding of all respective data to the representative of the DSO, in case of organ donation, is mandatory. – As nearly 50% of all brain death protocols since July 2015 disclose different degrees of inconsistencies (Bösebeck 2016), every examen for specialization in neurosurgery should contain at least one question concerning the determination of brain death.