B48. The notion and statement of brain death. Medico-legal prerequisites.

Page created on October 11, 2021. Not updated since.

Brain death

In Hungary, brain death is defined in the law as “the irreversible cessation of all functions of the entire brain, including the brain stem”. To determine brain death, the following steps must be performed:

There must be no exclusion criteria present, like:

• Poisoning, drug effects
• Coma due to shock, metabolic, endocrine conditions
• Hypothermia or hyperthermia
• CNS infection

If no exclusion criteria are present, we must confirm the total absence of brain function and that this absence is irreversible.

Confirmation of total absence of brain function:

• No motor activity at all, neither spontaneous nor upon stimulation
• Absent brainstem reflexes (pupillary reflexes, corneal reflexes, gag reflex, etc.)
• Apnoea test – measures brainstem activity
  • The patient is ventilated with 100% oxygen
  • Then disconnected from the ventilator
  • The patient is observed for spontaneous breathing
  • After 10 minutes, an ABG is performed and the PaCO2 is measured
  • If PaCO2 > 60 mmHg, there’s no activity of the brainstem respiratory centre
• (Spinal reflexes may still be present)

Confirmation of the irreversibility of absent brain function during the observation period:

• Repeat the above tests
• Imaging tests may be used to shorten the observation time (US, scintigraphy, angiography)

Brain death must be confirmed by 3 independent specialist doctors who go through all the steps and who agree unanimously.