Brain death and the donation of organs. A review in the light of current Spanish legislation

Primary brain death (BD) is a clinical situation characterised by the total and irreversible absence of functioning in the brain as a consequence of its being destroyed, while heartbeat and breathing are maintained by artificial means. The Royal Decree 2070/1999, dated 30 December, lawfully regulates the diagnosis of BD and the activities concerning the donation of organs for transplant in Spain. In certain patients who have suffered structural injury to the brain, serious intracranial hypertension occurs which blocks the blood flow throughout the brain, while breathing is maintained by mechanical means, together with heartbeat. The diagnosis of BD is eminently clinical and is based on the verification of three circumstances: the existence of a non reactive coma, the disappearance of brain stem reflexes and activity in its parasympathetic nuclei, and the absence of spontaneous breathing. The diagnosis can be reinforced with certain complementary tests, which in some cases are compulsory. In the paper we describe the explorations that are considered to be appropriate by current Spanish legislation. We also review the most important clinical and legal aspects of organ donation. BD is an iatrogenic state, known only since the development of reanimation and assisted ventilation techniques, which amounts to the death of the person. Obtaining organs for transplants is currently possible in Spain from donors in this situation, but also from those who have died from an initial cardiopulmonary arrest and from live donors.