Rigamonti  EFM, Varelas
 JM.

International guideline development for the determination of death. Race: Black.  TM. Brain death, the soul, and organic life.  P, Malledant  SM.  S, Kerz  SP, Bard In: Youngner  et al. Accommodating religious beliefs in the ICU: a narrative account of a disputed death.  CA, Vidal (Indicated by the phrase: “It is recommended that…”)Generated when there were potentially different options and the best action may differ depending on circumstances, patients, resources, or societal values, or where there is a need for further evidence or discussion among clinicians and stakeholders. Islamic ethics of organ transplantation and brain death. Determining brain death after therapeutic hypothermia on nonpulsatile continuous-flow mechanical circulatory support devices.  Luce  N. In some cases, economic, technological, or personnel constraints may result in limited ancillary testing choices; in other circumstances, existing laws may restrict adoption of all recommendations.  RM.  MA, Kalkines Canadian Blood Services.  J, López de Munain  Puttinger  F, Hilbert  MacDougall Persistence of cellular-level neuronal and neuroendocrine activity does not preclude the determination.  P, Malledant Current controversies in brain death determination.  D.  TJ, Kadri  L, Sudikoff  Bleck  NJ.  BJ, Robinson  F.  T, Boor 41 (Paolin), sensitivity is 53%, but the specificity is not calculated as the article is a study of consecutive brain death patients.

 G,  EF.  CH

 Spanish Royal Decree 1723/2012 regulating the activities of recovery, clinical use and territorial coordination of human organs intended for transplantation and setting quality and safety standards. Royal College of Paediatrics and Child Health. A cautious approach with serial examinations and consideration of an observation period is recommended to minimize the risk of diagnostic error.It is recommended that those in the pediatric population be observed for unresponsive coma for a minimum of 24 hours prior to initial testing following birth asphyxia, resuscitation from cardiac arrest, and after rewarming from therapeutic hypothermia.It is suggested that clinical criteria for determination of BD/DNC in newborns include the sucking and rooting reflexes.It is suggested that recommendations for apnea testing targets in pediatrics are the same as in adults.It is recommended that tracheal insufflation should not be used for apnea testing in newborns, infants, and young children.It is suggested there are no pediatric-specific distinctions related to performing the apnea test during extracorporeal support.It is recommended that ancillary studies are not routinely required to determine BD/DNC in the pediatric population.It is recommended that indications for ancillary testing are the same as in adults.It is recommended that, similar to adults, radionuclide cerebral blood flow study is an accepted and preferred ancillary study.It is suggested at present that EEG, performed and interpreted in accordance with published guidelines, is also considered a valid ancillary study in infants and children and can be used in certain jurisdictions.It is recommended that transcranial Doppler ultrasonography should not be used as an ancillary study in pediatrics until more studies determine the validity of this study in this population.It is suggested that in a person with chronic hypoxemia due to cyanotic heart disease, apnea testing not be performed and instead an ancillary study be conducted to assist with determination of BD/DNC.It is recommended that experienced pediatric clinicians with training and qualifications in pediatric critical care, neonatology, pediatric neurology, pediatric neurointensive care, neurosurgery, or traumatology perform testing to determine BD/DNC in pediatrics.It is recommended that standardized checklists be incorporated into the practice of determining neurologic death in pediatrics to reduce operator variability and diagnostic error.Patients requiring extracorporeal membrane oxygenation (ECMO) and other forms of extracorporeal support are at high risk of complications leading to brain injury and BD/DNC.

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