Determination of brain death

Czech version

Authors: Drahoslava Nováková; Otakar Kraft; Radoslava Drozdková
Authors‘ workplace: Klinika nukleární medicíny, FN Ostrava
Published in: NuklMed 2012;1:53-57
Category: Review Article

Overview

Introduction:
Brain perfusion scintigraphy serves as a reliable tool to determine brain death for transplantation medicine or for termination of resuscitation. Brain death means irreversible termination of all brain functions including functions of brain stem irrespective to persisting functions of cardiovascular system and other organs. Determination of brain death is an essential diagnosis for donation of organs for transplantation. Permission of removing organs from donors and rules for death determination is securely protected by the Czech legislation.

Method:
Examinations are performed with dual-head gamma cameras from Siemens in our department from year 2003. Radiopharmaceutical Tc-99m HMPAO is injected intravenously as a bolus. Dynamic phase is acquired in an anterior view, static phase in anterior, posterior and both lateral views.

Results:
We performed 124 examinations in 118 patients (103 adults and 15 children) with clinical symptoms of brain death – potential donors of organs from 2003 to June 2012. We do not confirm brain death in 8 patients. Organ removing was not performed in 23 patients due to different contraindications or due to lack of permission from parents or representatives in children.

Conclusion:
Brain perfusion scintigraphy is a non-invasive, simple and convenient method which is almost without false positive findings. There are no risks of complications. Therefore, its inclusion into the process of brain death determination is fully justified.

Key words:
brain death, brain scintigraphy, brain angiography, transplantation

Sources

1. Nařízení vlády č.436/2002 Sb. [online].[cit. 2012-07-13]. Dostupné na: http://aplikace.mvcr.cz/archiv2008/sbirka/2002/sb153-02.pdf

2. Vyhláška MZ č. 437/2002 Sb. [online].[cit. 2012-07-13]. Dostupné na: http://aplikace.mvcr.cz/archiv2008/sbirka/2002/sb153-02.pdf

3. Vyhláška MZ č. 479/2002 Sb. [online].[cit. 2012-07-13]. Dostupné na: http://aplikace.mvcr.cz/archiv2008/sbirka/2002/sb166-02.pdf

4. Zákon o darování, odběrech a transplantacích tkání a orgánů a o změně některých zákonů (transplantační zákon) č. 285/2002 Sb. [online]. [cit. 2012-07-13]. Dostupné na: http://portal.gov.cz/app/zakony/zakonPar.jsp?idBiblio=53599&nr=285~2F2002&rpp=15

5. Zákon č. 228/2005 Sb. [online].[cit. 2012-07-13]. Dostupné na: http://www.kst.cz/web/download/zakon_228.pdf

6. Národní registr osob nesouhlasících s posmrtným darováním tkání a orgánů [online].[cit. 2012-07-13]. Dostupné na: http://www.nrod.cz

7. Flowers WM, Patel BR. Accuracy of clinical evaluation in the determination of brain death. South Med J 2000;93:203-206

8. MINISTERSTVO ZDRAVOTNICTVÍ ČR. Standardy zdravotní péče. „Národní radiologické standardy – Nukleární medicína“. Soubor doporučení a návod pro tvorbu místních radiologických postupů (standardů) na diagnostických a terapeutických pracovištích nukleární medicíny v České republice. Věstník MZ ČR. Praha, 2011;9:142-144 [online].2011.[cit. 2012-07-13]. Dostupné na: http://www.mzcr.cz/Legislativa/dokumenty/vestnik-c9/2011_5340_2162_11.html

9. Donohoe KJ, Frey KA, Gerbaudo VH et al. Procedure guideline for brain death scintigraphy. J Nucl Med 2003;44:846-851

10. Spieth M, Abella E, Sutter C et al. Importance of the lateral view in the evaluation of suspected brain death. Clin Nucl Med 1995;20:965-968

11. Spieth ME, Ansari AN, Kawada TK. Direct comparison of Tc-99m DTPA and Tc-99m HMPAO for the evaluation of brain death. Clin Nucl Med 1994;19:867-872

12. Spieth ME, Devadas GC, Gauger BS. Procedure guidelines for brain death scintigraphy. J Nucl Med 2004;45:922

13. Bonetti MG, Ciritella P, Valle G et al. 99mTc HMPAO brain perfusion SPECT in brain death. Neuroradiology 1995;37:365-369

14. Facco E, Zucchetta P, Munari M et al. 99mTc-HMPAO SPECT in the diagnosis of brain death. Intensive Care Med 1998;24:911-917

15. Mrhač L, Zakko S, Parikh Y. Brain death: the evaluation of semi-quantitative parameters and other signs in HMPAO scintigraphy. Nucl Med Commun 1995;16:1016-1020

Labels

Nuclear medicine Radiodiagnostics Radiotherapy

Evolution of indications of nuclear medicine examinations in prostate cancer since the registration of fluorocholine (F-18): a two year survey at hospital Tenon

Hemodialyzed patient with thyroid cancer treated with I-131

Article was published in

Nuclear Medicine

2012 Issue 3