Background: In the absence of primary infratentorial brain lesions, the German guideline on brain death (BD) permits diagnosis based on two clinical assessments separated by a defined observational period or by one clinical assessment and an ancillary test. Methods: Retrospective analysis of patients fulfilling the clinical criteria of BD registered with the organ procurement organization of northeastern Germany during a 10-year period. Results: 2,745 patients were included. Compared to clinical observations, ancillary tests led to the confirmation of BD more frequently (98.7 vs. 78.7%) and after a considerably shorter diagnostic duration (median 1.4 vs. 16.5 h). Organ donation was more frequent with inclusion of ancillary tests (69.3 vs. 34.7% of diagnosed patients). The rate of fatal circulatory failure increased with longer observation. Nonconfirmatory results of the first ancillary test were more frequent with primary infratentorial lesions (14.3%) and hypoxic brain damage (7.9%) compared to primary supratentorial lesions (2.9%). Conclusion: When used as an alternative to clinical reassessment, ancillary studies increase the rate of BD determination and organ donation. An increased rate of initially negative ancillary studies with infratentorial brain lesions or hypoxic brain damage supports the use of different diagnostic pathways for these patients, as defined by the current German guideline.

1.
Haupt WF, Rudolf J: European brain death codes: a comparison of national guidelines. J Neurol 1999;246:432-437.
2.
Wijdicks EF: Brain death worldwide: accepted fact but no global consensus in diagnostic criteria. Neurology 2002;58:20-25.
3.
Citerio G, Crippa IA, Bronco A, Vargiolu A, Smith M: Variability in brain death determination in Europe: looking for a solution. Neurocrit Care 2014;21:376-382.
4.
Wijdicks EFM, Varelas PN, Gronseth GS, Greer DM: Evidence-based guideline update: determining brain death in adults. Neurology 2010;74:1911-1918.
5.
Wissenschaftlicher Beirat der Bundesärztekammer: Kriterien des Hirntodes. Deutsches Ärzteblatt 1998;94:A1296-A1303.
6.
Lustbader D, O'Hara D, Wijdicks EF, MacLean L, Tajik W, Ying A, Berg E, Goldstein M: Second brain death examination may negatively affect organ donation. Neurology 2011;76:119-124.
7.
Report of the ad hoc committee of the harvard medical school to examine the definition of brain death. A definition of irreversible coma. JAMA 1968;205:85-88.
8.
Camut S, Baumann A, Dubois V, Ducrocq X, Audibert G: Non-therapeutic intensive care for organ donation: a healthcare professionals' opinion survey. Nurs Ethics 2014;pii:0969733014558969.
9.
Wijdicks EF: The case against confirmatory tests for determining brain death in adults. Neurology 2010;75:77-83.
10.
Lustbader D, Wijdicks EF, Goldstein M: Second brain death examination may negatively affect organ donation. Neurology 2011;77:1314-1316; author reply 1315-1316.
11.
Joffe AR, Rady MY, Verheijde JL: Second brain death examination may negatively affect organ donation. Neurology 2011;77:1314-1316; author reply 1315-1316.
12.
Joffe AR, Duff JP: Defining death and organ donation: concerns about brain death discussion. Crit Care Med 2011;39:606; author reply 606-607.
13.
Shemie SD, Hornby L, Baker A, Teitelbaum J, Torrance S, Young K, Capron AM, Bernat JL, Noel L; The International Guidelines for Determination of Death phase 1 participants, in collaboration with the World Health Organization: International guideline development for the determination of death. Intensive Care Med 2014;40:788-797.
14.
Wijdicks EF: The transatlantic divide over brain death determination and the debate. Brain 2012;135:1321-1331.
15.
Joffe AR, Anton NR, Duff JP, Decaen A: A survey of American neurologists about brain death: understanding the conceptual basis and diagnostic tests for brain death. Ann Intensive Care 2012;2:4.
16.
Hoffmann O, Masuhr F: Zugang zur Hirntoddiagnostik. Der Nervenarzt 2014;85:1573-1581.
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