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The objective of the Latin American Network/Council of Donation and Transplant is to develop cooperation among its member states in all aspects related to donation and transplant of organs, tissue and cells. Given that diagnosing brain death (BD) is one of the key issues for the procurement of organs for transplant, the Network/Council seeks to contribute to defining the accepted concept of BD and its diagnosis and to disseminate this information among healthcare workers. In this report, we present the general guidelines on brain death and recommendations for clinical decisions after its diagnosis established and approved by the Latin American Network/Council of Donation and Transplant at its sixth meeting held in La Havana, Cuba, in May 2008. Although there are legal differences and variations in the diagnostic criteria used to define BD among its member states, brain death is accepted as the death of an individual for all legal, ethical and scientific effects. The diagnosis of BD should be independent of the decision of whether to donor or not donate organs for transplant. Once a diagnosis of BD has been confirmed, the possibility of organ donation should always be considered and the appropriate organ maintenance measures initiated. If organ donation is contraindicated, all support measures should be withdrawn including mechanical respiration. The decision to withdraw all support measures is consistent with the clinical-legal diagnosis and supported by several scientific and bioethics societies.

Objective: To examine the diagnosis of brain death (BD) in Latin America., Background: The term BD has long been used to define the death of an individual despite legal differences and variations in the diagnostic criteria applied in each country., Method: A survey was conducted to gain information on the medical and legal diagnosis of BD in the 21 countries that make up the Latin American Network/Council of Donation and Transplant., Results: All the Latin American countries except for Nicaragua legally recognize BD as the death of the person. To declare a person dead, 2 or 3 doctors are required in most countries. In all the countries, the requirements that must be fulfilled are unresponsive coma, lack of brainstem reflexes and of spontaneous breathing. Partial pressure of arterial carbon dioxide levels required in the apnea test vary from 50-60mm Hg. The minimum temperature required for a neurological examination ranges from 32 degrees -35 degrees C. The atropine test is mandatory in 7 (35%) countries. The most recommended observation period is 6h, but there is great variation and can be up to 24h. In 8 countries (40%), an instrumental test is obligatory, while in the remaining countries this is only undertaken under special circumstances. In some countries, when organs are not donated for transplant, support measures are not withdrawn, this being more frequent in children., Conclusions: There seems to be some uniformity in the main diagnostic criteria applied, with differences observed in clinical prerequisites, neurological exams, observation time, instrumental tests and the clinical decisions made following a declaration of BD. It is recommended that diagnostic criteria be standardized.