Assessment of process required to diagnose brain death in adult patients (demographics, clinical, laboratory, imaging, and treatment data). No questionnaires or study visits will be used.

the local brain death protocol ( = measurement tool) requires 1.) exclusion of the following conditions:

• shock (mean arterial blood pressure > 60 mmHg, lactate < 4 mmol/l)

• hypothermia (temperature > 35°C)

• severe acidosis (pH > 7.3)

• hyperosmolarity (osmolarity < 320 mmol/l)

• severe electrolyte disorders (sodium > 125 mmol/l, phosphate > 0.3 mmol/l)

• hypoglycemia (glucose > 4 mmol/l)

• hyperammonemia (ammonia < 60 mumol/l)

• uremia (urea < 25 mmol/l)

• prolonged effects of medication (muscle relaxants, sedatives, recreational drugs)

• severe hypothyreosis

  2.) clinical examination confirming:

• fixed pupils (dilated or mid-dilated bilaterally)

• absent vestibulo-ocular reflex

• absent corneal reflex bilaterally

• no reaction to painful stimulus bilaterally

• absence of cough and gag reflex

• absence of spontaneous breathing (apnea test)

number of physicians involved in the diagnostic procedures