Brain death investigation – survey of physicians in the Czech Republic

Czech version

Authors: P. Hollý ^1-3; E. Pokorná ⁴; M. Balík ⁵; D. Netuka ⁶; S. Ostrý ^3,6
Authors‘ workplace: Neurologická klinika a Centrum klinických neurověd 1. LF UK a VFN v Praze ¹; Ústav soudního lékařství 1. LF UK a VFN v Praze ²; Neurologické oddělení, Nemocnice České Budějovice, a. s. ³; Odborné edukační pracoviště pro dárcovství orgánů, Institut klinické a experimentální medicíny, Praha ⁴; Klinika anesteziologie, resuscitace a intenzivní medicíny 1. LF UK a VFN v Praze ⁵; Neurochirurgická a neuroonkologická klinika 1. LF UK a ÚVN – VFN, Praha ⁶
Published in: Cesk Slov Neurol N 2026; 89(1): 43-49
Category: Original Paper
doi: https://doi.org/10.48095/cccsnn202643

Overview

Aim: This article explores brain death assessment according to neurological criteria and evaluates a nationwide survey on diagnostic procedures. It also examines awareness among healthcare professionals. Methods: An online survey was conducted from January 7 to March 3, 2025, targeting 115 healthcare facilities. The questionnaire collected demographic data, specialties, and frequency of brain death assessments and examination of individual reflexes. Results: 523 respondents participated in the questionnaire survey, with 38% having experience in brain death assessment. A total of 187 physicians regularly examine brain death, with 74% of them performing fewer than five examinations per year. The most common specialists were anesthesiologists (48%) and neurologists (27%). Most physicians (50%) follow the IKEM “Život²” manual. The main reason for the examination (61%) was the donor program. The apnea test is performed by 81% of respondents, 90% of them only after a clinical examination. The most commonly used confirmatory method is CTA (26%), while 43% of physicians indicate confirmatory testing only in the case of a donor program. Conclusion: A questionnaire survey revealed the existence of interindividual differences in the investigative procedure for clinical determination of brain death in the Czech Republic. The consistency of clinical examinations is insufficient in patients referred to the donor program. In contrast, the apnea test is unnecessarily overused in examinations conducted as part of the decision-making process regarding futile care limitations. The findings emphasize the need for enhanced education on brain death assessment, particularly those who rarely encounter this diagnosis. It is also crucial to understand the concept of brain death and how it is communicated both among healthcare professionals and to the public.

Keywords:

diagnosis – brain death – neurological criteria – donor program – brain-stem refl exes

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