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Brain Death World Wide: Accepted fact but no global consensus in diagnostic criteria

While the concept of brain death is widely accepted, no universal criteria exist for its determination. This study compared guidelines from 80 countries finding that all standards specified exclusion of confounders, irreversible coma, absent motor response, and lack of brain-stem reflexes (see Wijdicks, “The Diagnosis of Brain Death” for more information). The majority of countries had medical practice standards (88%), legal standards (69%), utilized some form of apnea testing (59%), and required more than one physician’s declaration (50%). Specifics varied widely on the qualifications of the physician, methods of apnea testing, and observation time before pronouncement of death. Regional differences were also noted, such as mandatory laboratory tests in Europe and Asia. Within the United States, brain death determination has been left to each state to decide (44 states and the District of Columbia have guidelines) whereas most African countries do not. Even if guidelines are not standardized, it is clear there is a universal acceptance of brain death as a concept. Dr. Wijdicks concludes his survey with a call for an international task force on brain death guideline standardization, or, alternatively reexamination and revision of each country’s individual guidelines should cultural and religious beliefs dictate national policy.