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Brain death

German: Hirntod

1 Definition

Brain death is a definition for a person's death. The determination of brain death is an important step that has to take place before explantation of an organ to be used for organ donation or transplantation.

2 Legal situation

2.1 Legal situation in Germany

Article 3, paragraph 2 of the Transplantation Act (Transplantationsgesetz) says that the removal of organs is unlawful if

  1. the person whose death has been determined had previously objected to organ removal
  2. the definitive and irremediable failure of the cerebrum, cerebellum and brain stem has not been determined according to procedures that comply with the state of knowledge in the medical sciences.

3 Determination of brain death

Brain death has to be determined independently by two different physicians. The involved physicians must have years of experience in neurology and cannot themselves take part in the process of transplantation.

Clinical signs of brain death are amongst others:

Instrumental examinations which can be used to determine brain death:

Only medical specialists may determine brain death. One of the two examining specialists has to be a neurologist or a neurosurgeon. A paediatrician is necessary for the examination of children up to the age of 14. If he is neuropaediatrician, then it is not necessary that the second consultant is neurologist. These qualified and responsible specialists have to exclude other causes that could lead to symptoms of brain death. Those causes include:

In Germany, findings that lead to determination of brain death have to be recorded in a standardized Brain Death Protocol (Hirntodprotokoll). For patients under 3 years of age and unclear causes for a coma, modified criteria are used to determine brain death.

Die Richtlinie zur Hirntoddiagnostik der Bundesärztekammer fordert den Facharztstandard. Erfahrung in der Neurologie ist nicht ausreichend.
#1 at 18.04.2017 from Dr. med. Martin P. Wedig (Physician)

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