DIAGNOSIS OF BRAIN-DEATH IN THE CATCHMENT -AREA OF THE NEUROLOGICAL-CLINIC-OF-ERLANGEN-UNIVERSITY BETWEEN 1984 AND 1994

Objective: The reliable diagnosis of brain death is a precondition of organ removal for subsequent transplantation. As demographic data, inf ormation on the underlying cause and written consent to organ removal from brain-dead patients are largely unknown; protocols relating to th e determination of brain death were analysed to obtain these data. Pat ients and methods: The study was based on an examination of the protoc ols of 547 consecutive and unselected patients who between 1984 and 19 94 had been examined for possible brain death by experienced members o f the Neurological Department of Erlangen University, in consequence o f the establishment of a consultation service for this purpose to hosp itals in the region of North Bavaria. The criteria of brain death were those established by the Federal German Doctors' Chamber, all the dat a in the written protocol being analysed retrospectively. Results: Bra in death was confirmed in 521 patients (319 males, 202 females; mean a ge 40.1 [1.5-84] years). 473 patients (86.5%) had been examined at the Erlangen University Clinic or the Municipal Hospital in Nuremberg, th e remainder in regional hospitals. The most common causes were trauma to the head/brain (43.5%), subarachnoid haemorrhage (18.6%), generalis ed hypoxaemia (9.5%), cerebral infarction (7.3%) or other conditions ( 4.5%). 33 patients (6%) had committed suicide. Organs were removed in 244 of 413 patients (59.1%) for whom there were data on possible organ removal: seven patients had carried donor cards, relatives' consent w as obtained in 237. No consent was given in 90 cases (21.8%), while 79 (19.2%) were excluded for medical reasons. Conclusion: If brain death is suspected, an experienced neurological consultant should be called in as soon as possible to assess the patient's survival chances and e valuate possible organ removal for subsequent transplantation.