The majority of European countries have published recommendations for the d
iagnosis of brain death as a necessary prerequisite for organ donation. The
concept of brain death as defining the death of the individual is accepted
in all European countries; however, the guidelines for determining the tot
al and irreversible loss of all brain functions differ somewhat in the vari
ous countries. While the clinical examination and documentation of the clin
ical signs of brain death are very uniform, there are significant differenc
es in the guidelines for using technical confirmatory tests to corroborate
the clinical signs. These range from rejecting all technical tests to accep
ting of multiple neurophysiological tests alone or in combination. The pres
ent study examined the similarities and differences in current concepts of
brain death in the various European countries and their recommendations for
the diagnosis of brain death. The diagnosis of brain death is based on a n
umber of prerequisites, on the clinical diagnosis of deep coma, loss of all
brainstem reflexes, and the demonstration of apnea. Neurophysiological tes
ts are recommended by a number of national professional societies as confir
matory tests to confirm the clinical diagnosis of brain death and shorten o
therwise necessary waiting periods of 6-12 h. Most brain death codes allow
the use of electroencephalography, which must demonstrate electrocortical s
ilence over a certain period. Evoked cerebral potentials can demonstrate th
e successive loss of activity of various afferent pathways and are accepted
in some countries as a confirmatory test. Other neurophysiological tests w
hich demonstrate the loss of cerebral perfusion can be implemented. Brain s
cintigraphy can confirm the loss of isotope uptake into the, brain. Doppler
sonography also demonstrates cessation of brain perfusion. Cerebral panang
iography may also be used to demonstrate the loss of brain perfusion but is
less desirable since it might endanger the patient.