DETERMINATI

ON OF DEATH
 WHAT IS DETERMINATION
OF DEATH?
An individual who has sustained either (1)
irreversible cessation of circulatory and respiratory
functions, or (2) irreversible cessation of all functions
of the entire brain, including the brain stem, is dead.
A determination of death must be made in
accordance with accepted medical standards.

Endorsed by American Academy of Neurology and

the American Electroencephalographic Society
TRADITION CRITERIA FOR
DETERMINING DEATH
Circulation and Respiration (19th century to late 1960s)

The traditional notion of cessation of circulation and respiration

as the basis for a determination that death had occurred. The
cessation of other organ system, such as the brain, liver or
kidneys, was significant as an indicator of death only to the
extent that it caused heart and lung activity to cease.
THE BRAIN DEAD STANDARD
In 1969, new criteria for determining death has began to emerge.
In that year a committee in
THE CRITERIA THAT PHYSICIANS USE IN
DETERMINING THAT DEATH HAS
OCCURRED SHOULD:
Eliminate errors as possible in classifying a living
individual as dead
Allow as few errors as possible in classifying a dead
body as alive
Allow a determination to be made without
unreasonable delay
Be adaptable to a variety of clinical situations
Be explicit and accessible to verification
THE CRITERIA FOR DETERMINATION OF
DEATH
A. An individual with irreversible cessation of circulatory and
respiratory functions is dead
Cessation is recognized by an appropriate clinical examination
Clinical examination will disclose at least the absence of
responsiveness, heartbeat, and respiratory effort
Medical circumstances may require the use of confirmatory
tests, such as BCG
Irreversibility is recognized by persistent cessation of functions
during an appropriate period of observation and/or trial of
therapy
B. An individual with irreversible cessation of all functions of the
entire brain, including the brainstem, is dead.
Cessation is recognized when evaluation discloses findings of a
and b:
a. cerebral functions are absent
b. brainstem functions are absent
Irreversibility is recognized when evaluation discloses findings of
a, b, and c:
a. the cause of coma is established and is sufficient to account
for the loss of brain functions.
b. the possibility of recovery of any brain functions is excluded
c. the cessation of all brain functions persists for an appropriate
period of observation and/or trial of therapy
COMPLICATING CONDITIONS
Drug and Metabolic Intoxication
- most serious problem in determination of death, especially when multiple
drugs are used
- caused by sedative and anesthetic drugs such as, barbiturates,
methaqualone, meprobamate
- may be reversible even though they produce chemical cessation of brain
functions and electro cerebral silence
- death may not be declared if exogenous intoxication is found, until the
intoxicant is metabolized
- total paralysis may cause unresponsiveness, areflexia, and apnea that
closely simulates death
Hypothermia
- determination of death are not available in the presence of hypothermia
(32.2C core temperature)
- can mimic brain death by ordinary clinical criteria
- can protect against neurologic damage due to hypoxia
-not common cause of difficulty in the determination of death