International perspective on the diagnosis of death

Abstract

There is growing medical consensus in a unifying concept of human death. All human death involves the irreversible loss of the capacity for consciousness, combined with the irreversible loss of the capacity to breathe. Death then is a result of the irreversible loss of these functions in the brain. This paper outlines three sets of criteria to diagnose human death. Each set of criteria clearly establishes the irreversible loss of the capacity for consciousness, combined with the irreversible loss of the capacity to breathe. The most appropriate set of criteria to use is determined by the circumstances in which the medical practitioner is called upon to diagnose death. The three criteria sets are somatic (features visible on external inspection of the corpse), circulatory (after cardiorespiratory arrest), and neurological (in patients in coma on mechanical ventilation); and represent a diagnostic standard in which the medical profession and the public can have complete confidence. This review unites authors from Australia, Canada, and the UK and examines the medical criteria that we should use in 2012 to diagnose human death.

Brain Death in Children

“…Strict adherence to published guidelines and medical standards for determining brain death is the minimum requirement for maintaining public trust. The neurological criteria, as outlined above, represent international practice in which the medical profession and the public can have complete confidence [16]. The use of checklist promotes the necessary documentation of each part of declaration of BD and is strongly recommended [2,21,24].…”

“…In the USA, Australia, and New Zealand for example, a whole brain death definition is accepted. On the contrary, in the UK, India, and Canada a brainstem-based definition of death is in place and the term "death by neurological criteria" (DNC) is adopted [13][14][15][16]. In the UK, the most recent definition for DNC was published in 2008 by the Academy of Medical Royal Colleges (AoMRC) in the code of practice for the diagnosis and confirmation of death.…”

Physiologic Monitoring: Improving Safety or Increasing Risk?

“…However, cessation of breathing remained the cardinal sign of death, and apnea was the usual sign that death had occurred. 11 Auscultation of the chest could detect faint breathing efforts that may not have been apparent to the unaided eye. Once the prognosis was confirmed as grim, family members stayed with the dying patient (death watch) and were the ones who identified the time of death when breathing stopped.…”

Brain Death

“…Some Muslim countries adopted this definition of death after the enactment of the Uniform Determination of Death Act (UDDA) in the United States, which stated that: An individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) This Fatwa concurs with the Fatwa of High Scholars of Saudi Arabia (including the grand Mufti Sheikh Bin Baz) which was passed in 1983, and allowed stopping the ventilators from brain dead persons, as it was considered futile to continue hooking such persons to machines; but death will not be announced until after the stoppage of circulation and respiration [39].…”