Ethics Committee Core Curriculum
Determination of Death
Voluntary Consensus Guidelines for Determination of Death
A. GENERAL STATEMENT OF POLICY:
The purpose of this policy is to clarify and standardize the clinical criteria for the determination of brain death. Title 10 section 400.16 states:
a. An individual who has sustained either:
b. A determination of death must be made in accordance with accepted medical standards.
- Irreversible cessation of circulatory and respiratory functions; or
- Irreversible cessation of all functions of the entire brain, including the brain stem, is dead.
1. CARDIOPULMONARY CRITERIA:
An individual with irreversible cessation of circulatory and respiratory function is dead.
a. Cessation is recognized by appropriate clinical examinations. Clinical examination will disclose at least the absence of responsiveness, heart beat, and respiratory effort. Medical circumstances may warrant, but do not require, the use of conf
irmatory tests such as EKG.
b. Irreversibility of cardiopulmonary function is recognized by persistent cessation during an appropriate period of observation and/or trial of therapy.
- (i) In clinical situations where death is expected, where the cause has been gradual and where irregular, agonal respirations, or cardiac activity finally ceases, the period of observation following the cessation of cardiopulmonary function may
need to be only a few minutes in order to establish death.
- (ii)When a possible death is unobserved, unexpected, or sudden, the examination may need to be more detailed or extend over a longer period while appropriate resuscitative efforts are maintained as a test for cardiovascular responsiveness.
2. NEUROLOGIC CRITERIA:
An individual with irreversible cessation of all brain function, including the brain stem, is dead. Where indicated, the clinical diagnosis may be confirmed by laboratory testing.
- a. The existence of brain death can be certified by a single physician skilled in the techniques of brain death assessment. However, in instances where the patient is a potential organ and/or tissue donor, a second physician must also certify
the time of death.
- b. Each hospital should establish a process to identify and privilege physicians in brain death determination. An assessment that the clinical criteria contained in this policy have been satisfied requires the judgement of a physician competen
t in the medical knowledge relevant to determining brain death.
- c. The specific criteria for brain death determination are delineated in Attachment A, "Guidelines for Determination of Death by Irreversible Cessation of All Functions of the Entire Brain, Including the Brain Stem."
All applicable items must be marked "Yes" in order for brain death to be declared.
- d. Confirmation by EEG or cerebral blood flow determination can shorten the interval of observation required for brain death determination. These ancillary procedures are, however, not required for the determination of brain death.
- e. The patientís attending physician shall participate in the determination of brain death wherever possible. If the attending physician is not certified by the hospital as skilled in the application of the criteria, another physician having s
uch competence must be consulted. A neurologist or neurosurgeon is not specifically required.
- f. Brain death is a medical determination and does not require specific consent from the patientís next-of-kin or health care agent. Under New York State law and regulation, however, reasonable efforts must be made to notify next-of-kin or clo
sest individual that the determination of death process is being undertaken.
- g. The hospital must have policies and procedures to reasonably accommodate situations in which the patient had expressed or next-of-kin or other person closest to the individual expresses on the patientís behalf a religious or moral objection
to the brain death standard as a basis for declaring the individual dead. Counseling by staff considered appropriate by the attending physician and the hospital may be made available to assist in this process. Attachment C pro
vides important and helpful ways to implement policies and procedures to reasonably accommodate such situations.
These criteria may apply to all persons above the age of one. They should not be applied to children less than one. For children less than one year, see Attachment B.
Direct questions about the posting of this report to
Dr. Brad Truax
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Last Revised 3/20/97