[Inconsistency between clinical practice and the medical terminology in criteria for the determination of brain death]. / Neuskladenost klinicke prakse i nazivlja s postojecim pravilnikom o utvrdivanju smrti mozga.

Transplantation of odd organs such as heart, liver, pancreas and alike is possible only through dead donors and cadavers, so the study and research into the exact time of death is of paramount importance. It is understood that a person is dead when the brain is dead, and from that moment on there is no reason to sustain or prolong the life of the remaining living cells, so called vegetating living, as governed by the Criteria for brain death. In our country the criteria are dated 1982 and the article 5 was subsequently changed in 1991. We noticed that some articles of the Criteria were incorrect. The article 4, paragraph 9, should be altered because the 3-minute apnea testing is not sufficiently long. The laws and various criteria many times lag behind the actual practice in everyday life. This also applies to other laws and regulations in connection with medical practice, which although is developing fast is kept at bay due to slow changes of the laws. This is the case of the criteria regarding the brain death which have been adopted without any further thought from the criteria of former Yugoslavia. Due to this there have been disagreements regarding medical terminology and the laws which govern clinical results. Article 5 from 1982 and article 5 from 1991 have one thing in common, the EEG. The Criteria require EEG although it is not a very reliable method and is not required in many other countries. The criteria excluded the necessity of cerebral angiography which was shown to have more exact results, although it is more complicated. Radioisotope angiography has been excluded as well. The doppler ultrasound method has been included in the Criteria, although it is not available to many hospitals and, as mentioned previously, could give false positive results. The EP have been included in the Criteria as a reliable method, but unfortunately not available to many hospitals due to the lack of equipment and trained doctors and other medical personnel. Among other difficulties there are differences in medical terminology between medical experts, and the awareness of different medical terminology between nations, but the original Harward Criteria dated 1968 remain the same.