Physician Better Brain Death Diagnostics required

Physicians demand from the Federal Medical Association more severe brain death diagnosis

03/26/2014

After a series of incorrect brain death diagnoses have become known in recent weeks, physicians now demand in an open letter to the German Medical Association stricter rules for the detection of brain death. In future, only physicians with additional qualifications should be allowed to make the diagnosis.

Open letter to the German Medical Association
Several physicians have called for stricter criteria for the detection of brain death in an open letter to the President and vice-president of the German Medical Association, Frank Ulrich Montgomery and Martina Wenker. In addition, in the future only physicians with higher qualifications should be allowed to detect a brain death. Background of the action are errors and irregularities in brain death diagnostics, which have been problematized in recent days by the German Foundation for Organ Transplantation (DSO) in various media. These are eight cases between 2011 and 2013, when not all criteria for detecting brain death were correctly met.

Not every clinic has enough experts
The guidelines of the German Medical Association state how physicians should diagnose brain death. According to this, two physicians experienced in the field of intensive care must independently detect brain death by carrying out various physical and technical examinations. However, the scope of experience is sometimes very limited, since doctors do not have to carry out a corresponding diagnosis several times a year in every hospital. Moreover, not every clinic has several experts in the field. If there is a corresponding defect, the clinics may request medical assistance from the DSO.

Possible organ donors unsettled
It was precisely these DSO physicians who in several cases had discovered the mistakes made by colleagues in the hospitals. The cases in question were discussed by the DSO in retrospect in collaboration with a neurologist. The managing doctor of the DSO in Bavaria, Thomas Breidenbach said in an interview with Spiegel-Online: „The examples show how well our control system works.“ But despite all this, the mistakes above all confuse those who may want to volunteer for organ donation. The number of organ donors dropped to 876 last year. Compared to 2012, this represents a decline of 16 percent. Even if the cause is mainly the transplant scandals, the uncertainty due to reports of incorrect brain death diagnoses is unlikely to improve the situation.

Only physicians with additional qualifications should be allowed to make a diagnosis

In their open letter, therefore, the neurologists Hermann Deutschmann, Elisabeth Rehkopf and Robert Schumann and the neurosurgeon Christoph Goetz and the transplant surgeon Gundolf Gubernatis „the introduction of an additional term 'brain death diagnosis' in the continuing education regulations of the German Medical Association. Only physicians who have the additional name should be allowed to detect brain death.“ In addition, the guidelines should be revised so that toxicological examinations must be made in order to exclude drugs in the patient's blood.

No reaction from the German Medical Association
The initiative of the physicians finds broad support. The German Society for Neurology, the German Society for Neurosurgery and the German Society for Neurointensive and Emergency Medicine had also demanded a better qualification of the investigators. In addition, DSO board member Rainer Hess said in an official statement that it was in DSO's interest, „to increase the requirements for the qualification of doctors for brain death diagnostics.“ The experts could then be requested from the removal hospitals. From the German Medical Association, which is now on the train, there was no official response. (Sb)