Conﬁrmatory tests following reversal to whole brain death criteria atter 15 years long use of brain stem death criteria in Poland
R Bohatyrewicz, A Bohatyrewicz, M Zukowski, E Marzec-Lewenstein, J Biernawska, J Sołek-Pastuszka, A Walecka, M Sawicki
Ann Transplant 2009; 14(1): 21-21
First Polish whole brain death criteria were published in 1984. Instrumental tests such as EEG and cerebral angiography were obligatory. In 1990, following British regulations, brain death diagnosis was based on clinical brainstem death criteria. Consequently the knowledge about procedures dedicated to brain death diagnosis dissapeared between specialists of radiology and neurology. In 2007, new Polish code of practice reversed brainstem death criteria to the whole brain death criteria. Instrumental confirmatory tests became optional and in certain cases obligatory. Aortoarteriography, transcranial Doppler and cerebral scintigraphy were recommended among cerebral perfusion tests. Alternatively electrophysiological tests such as electroencephalography or brain stem evoked potentials may be used. Angio CT and perfusion CT were not recommended because of no experience with these methods in Poland and lack of widely accepted criteria in international literature. Currently, electrophysiological tests and trancranial Doppler are hardly available due to deficiency of equipment and experienced specialists. Additionally, cerebral angiography became unavailable too, because this method is recently used only in departments of neuroradiology and invasive radiology in a limited number of biggest hospitals. Angio CT and perfusion CT seem to be the methods of choice in future, because many local hospitals will be soon equipped with new generations of multidetector computed tomographs. Additionally the method is simple, cheaper and less invasive than conventional angiography. Therefore, multicenter trial is currently planned, in order to compare the results of conventional angiography with angio and perfusion CT. Afterwards, a precise instruction will be implemented during the next revision of Polish brain death criteria.
Keywords: Organ Procurement