Brain death diagnosis in misleading conditions

The necessity of defining brain death (BD) arose from technological develop ment in medical science. The definition of this concept had practical conse quences and opened the way to organ donation from ED patients. Nowadays, th e imbalance between the number of organs available for transplantation and the size of the demand is becoming critical. In most laboratories, a ED dia gnosis is made according to precise criteria and in a well-defined process. ED diagnosis should be improved, not only to assure the safety and to pres erve the human dignity of the patient, but also in order to increase the ra te of organ donation. By analysing some epidemiological parameters in ED di agnosis and organ donation, it appears that ED diagnoses can be made more o ften and more vapidly if one has a reliable, accurate, and safe confirmator y test, especially under misleading conditions (hypothermia, drugs, metabol ic disturbances). In our experience, the use of multimodality evoked potent ials (MEPs) to confirm a ED diagnosis has many advantages: MEPs can be rapi dly performed at the patient's bedside, assess the brain stem as well as th e cerebral cortex, and are innocuous for the patient. Moreover, their insen sitivity to the aforementioned misleading factors is sufficient to distingu ish ED from clinical and EEC states that mimic ED. They give an immediate d iagnosis, and no delay is required in ED confirmation if there is sufficien t cause to account for ED. MEPs are a safe, accurate, and reliable tool for confirming a ED diagnosis, and their use can improve the organ donation ra te while preserving the safety of the patient.