Laws & Regulations:

The bill of transplanting deceased organs was offered to parliament in 1993, but it wasn’t passed. Following the judgment of Grand divisions, the justifiability of this fact refer to the society's needs, Parliament has accepted the preliminary approval of organ transplantation from brain death in 1999, and the Sixth parliament accepted the final approval of this plan in 2000, finally Guardian Council House announced his judgment, and accepted it in 2000 then the President of Parliament announced it as a law. Finally after Codification and Notification of detection and confirmation of brain deathprotocol, the cabinet has passed the implementing regulations in 2002.

 

 

 

Protocol of brain death identification in Iran

Following the Act of codification of brain death committee, determination and confirmation standard of brain death is announced in six items and three notes, which is as follows.

 

1- Brain death

 

Brain death is irreversible end of all brain activities include  Cortical, Sub-cortical and Brain stem at the same time, which is completely in accordance with Clinical characteristics and conditions which is marked with their notes in the related items.

 

2- Condition of brain death

 

A) Patient is in deep coma.

I. There is no evidence of usage of CNS depressant drugs.

II. There is no evidence of Hypothermia (Temperatures less than 32 C) that causes deep coma.

III. There is no metabolic disorder,Toxic disorders and Endocrine disorders that causes deep coma.

 

B) Absence of spontaneous breathing so that patient is depended to artificial respiratory (Ventilator).Rejection of retractor drugs (nervous - muscle Inhibitors factor) and other drugs, as aRespiratory insufficiency factor is necessary.

 

C) The cause of coma should be defined.

 

 

 

3- Clinical examination

 

A) No spontaneous movement and no response to painful stimulus.

 

B) Absent brain stem reflexes

I. Absent pupillary reflex.

II. Absent corneal reflex.

III. Absent doll's eye.

IV. Absent vestibular ocular reflex.(Occulovesibular)

V. Absent Gag reflex.

 

4- Final confirmation ofthe clinical findings is happened by doing clinical tests and demonstrating it.

 

A) Positive Apnea test: 100% oxygen is given to patient 10 minute before separating him from artificial respiratory (Ventilator). After separation, 6 litter oxygen in each minute, is given to him and are allowed to reach 60 Mm Hg. If there is no respiratory activity, the Apnea test is positive and it shows brain death.

 

B) EEG should be done twice and at least in each 6 hours and it should be lasted 20 minutes. When EEG is isoelecteric in double times, shows brain death.

 

 

5- All clinical findings and clinical tests should be fixed for 24 hours.

 

6- Doctors that determining brain deathsupplement the specific forms ofconfirmingbrain death.

 

 

Two neurologists or a neurologist and a neurosurgeon should examine the brain death donor separately and fills the special form and singes it. This form is also should fill by a p anesthesiologist, an internal medicine and a doctor who is the agent of Legal Medicine Organization, and he should singe it too.

 

 

Not 1 - Time for patient care under artificial respiratory (Ventilator) at children less than 5 years should be 72 hours at least.

Not 2 – Investigation of brain death is started by treatment doctor request and through medical consultation.

Not 3 –Attachment form should be filled completely for each brain death and sending to ministry of health.

 

 

Doctor Mohammad Farhadi

Minister of Health and Medical Education