Objective: To determine the understanding of the conceptual basis and diagnostic tests used for brain death (BD) by neurosurgeons in Canada.
Methods: Between February and June 2006, a previously developed survey was mailed to every neurosurgeon in Canada.
Results: Of 223 surveys mailed, 147 (66%) were returned; of these, 128 (87%) were completed and analyzed. When asked to choose a conceptual reason to explain why BD is equivalent to death, 50 (39%) chose a higher brain concept, 50 (39%) chose a prognosis concept, and 33 (26%) chose a loss of integration of the organism concept. More than half of respondents answered that BD is not compatible with electroencephalographic activity or brainstem evoked potential activity. More than one-third of respondents answered that some cerebral blood flow or a brainstem with minimal microscopic damage was not compatible with BD. Of the 90 respondents who answered that they were comfortable diagnosing BD because the conceptual basis of BD makes it equivalent to death of the patient, in their own words, 14 (16%) used a loss of integration concept, 20 (22%) used a prognosis concept, 25 (28%) used a higher brain concept, and 39 (43%) did not articulate a concept. When asked, "Are brain death and cardiac death the same state (i.e., are both death of the patient)?," 57 (45%) answered "No."
Conclusion: Within the neurosurgical community, a stand-alone concept of BD does not exist. There is also significant variability in the understanding of the tests that are compatible with the criterion of BD.