Brain arrest, cardiac arrest and uncertainties in defining death

In this issue Lago et al. describe the existing realities of brain death in Latin America as evaluated retrospectively in seven Brazilian pediatric intensive care units (PICU) and demonstrate some revealing observations. The investigators document substantial geographic variation in the diagnosis suggestive of differences in applying the clinical examination rather than differences in case mix. Similar to the variabilities in diagnostic criteria described in other countries there is also lack of uniformity in the use of complementary exams. In northeastern and southeastern Brazil the extended time interval from diagnosis of death to the removal of support technology is of particular concern. This indicates that many physicians are concerned about stopping life support technology after brain death is diagnosed. The extremely poor incidence of organ donation reflects a discomfort with the issues of death and the use of human organs for transplantation in Brazilian society and within the Brazilian health care profession. (excerpt)