Maayke Hunfeld

239 General discussion Worldwide, perceptions and criteria of BD definition differ, for both adults and children (39-41). Examples of differences in perceptions include: acceptance of BD as death, religious beliefs and cultural norms about death, and legal standards of determination of BD and death. Regarding the practices, there is a great diversity in the availability of national and or institutional BD protocols and in the criteria to determine BD. For instance, requirements for physicians’ expertise to be allowed to determine BD (pediatric neurologists, pediatric neurosurgeons or pediatric intensivists, consultants or residents etc.) may differ, as well as the required minimum number of physicians involved in the decision. Issues such as the timing and necessity of repeated neurological exams, and the choice and timing of ancillary tests may also vary between countries. In the Netherlands, a neurological exam AND confirmatory tests (EEG, TCD, or CT-angiography) and finally the apnea test are required to determine ’whole’ BD (for the purpose of possible organ donation) in both adults and children. Ancillary tests are only done when neurological exam and apnea testing can be performed reliably and completely (38). In children younger than 1 year, the whole procedure must be repeated after a certain age-dependent waiting time. In the United States and the United Kingdom, however, only a neurological exam with apnea testing will suffice for the determination of pediatric BD. Ancillary tests can be used when parts of the neurological exam or apnea testing cannot be completed safely or adequately. Consensus among leading experts in the field is desirable. Future efforts will need to involve physicians with neurological and critical care expertise, representatives of national and international major medical organizations (such as the World Health Organization or World Federation of Neurology), and scientific and medical advisors of government agencies (39). However, due to the enormous variation in perception and practices among countries, the question arises whether agreement on international standards and practices of BD is an achievable goal. Part 3. Long-term outcome after out of hospital cardiac arrest Follow-up program As part of standard care, pediatric OHCA survivors are invited to participate in our multidisciplinary follow-up program at the outpatient clinic 3-6, 12 and 24 months after OHCA and subsequently, dependent on the age at time of arrest, at the ages of 5, 8, 12 and 17 years. During on-site visits, a semi-structured interview with the children and their caregivers takes place, and both a physical and neurological exam are performed as well as neuropsychological assessments by psychologists. This 8