Brain death

The brain death or encephalic death of a patient is considered equivalent to the death of that patient. It means irreversible and catastrophic brain damage. It is a process of ischaemic necrosis of the brain due to a cessation of blood flow, despite cardiac activity continuing.

Once the brain has been damaged in this way, doctors can do nothing more to save the patient's life.

Causes of brain death

The leading cause of brain death is stroke (also known as cerebrovascular accident, or CVA).

Other causes of brain death include:

• anoxia (a sudden lack of oxygen),
• poisoning,
• head injuries not related to road traffic accidents.

Diagnosis of brain death

Brain death is diagnosed on the basis of statutory clinical criteria. It is pronounced by two doctors who are independent of the organ harvesting and transplant teams.

In Luxembourg, several examinations must be carried out, and the result of each of these procedures must lead to the conclusion that the patient has died.

• A neurological examination is carried out. The objective is to check for the presence of brain stem reflexes in comatose patients who no longer show any spontaneous activity or any reaction to pain.
• The neurological examination is supplemented by an apnoea test, which verifies that the donor's breathing is purely artificial and being maintained only by the ventilator.
• The neurological clinical examination is then confirmed by paraclinical tests.
• The absence of any residual electro-encephalographic signals must be demonstrated. The EEG or the recording of somatosensory and auditory-evoked potentials must be isoelectric – i.e. flat.
• The final test required to prove brain death is a contralateral carotid and vertebral angiography to confirm the absence of cerebral blood flow.

Removal of organs

When a person is declared brain dead, artificial respiration and other resuscitation techniques can be used to artificially maintain the functioning of that person's other organs for a considerable length of time (tens of hours).

It is at this point, after all attempts to keep the deceased person alive have failed, that organ removal is considered.

It is a very specific situation: a dead patient is still looked after in order to treat and save other patients.