Diagnosis of brain death in Brazil

ABSTRACT Brain death, defined as the complete and irreversible loss of brain functions, has a history that is linked to the emergence of intensive care units and the advancement of artificial ventilatory support. In Brazil, by federal law, the criteria for the diagnosis of brain death have been defined by the Federal Council of Medicine since 1997 and apply to the entire Brazilian territory. Resolution 2,173/2017 of the Federal Council of Medicine updated the criteria for diagnosing brain death. These changes include the following: the requirement for the patient to meet specific physiological prerequisites and for the physician to provide optimized care to the patient before starting the procedures for diagnosing brain death and to perform complementary tests, as well as the need for specific training for physicians who make this diagnosis. Other changes include the reduction of the time interval between the two clinical examinations, the possibility of continuing procedures in the presence of unilateral ear or eye injury, the performance of a single apnea test and the creation of a statement of brain death determination that includes the recording of all procedures in a single document. This document, despite the controversy surrounding it, increases the safety necessary when establishing a diagnosis of such importance and has positive implications that extend beyond the patient and the physician to reach the entire health system.摘要：脑死亡（brain death）被定义为大脑功能完全且不可逆的丧失，其发展历程与重症监护病房（intensive care units）的兴起及人工通气支持技术的进步息息相关。在巴西，根据联邦法律，脑死亡诊断标准自1997年起由巴西联邦医学委员会（Federal Council of Medicine）制定，并适用于巴西全境。巴西联邦医学委员会第2173/2017号决议对脑死亡诊断标准进行了修订更新。此次修订包含以下内容：要求患者满足特定的生理学前置条件，医师在启动脑死亡诊断流程前需为患者提供优化诊疗照护并完成辅助检查，同时要求参与该诊断的医师接受专项培训。其他修订内容包括缩短两次临床检查之间的时间间隔，允许在单侧耳部或眼部损伤的情况下仍可继续诊断流程，仅需开展一次呼吸暂停试验（apnea test），并新增脑死亡判定意见书格式，要求将所有诊断流程记录整合至单份文件中。尽管该文件仍存在一定争议，但它提升了此类至关重要的诊断工作所需的安全性，其积极影响不仅惠及患者与医师，更覆盖整个医疗卫生系统。