Ethics Committee Core Curriculum

Determination of Death
Consensus Conference

Voluntary Consensus Guidelines for Determination of Death

A. GENERAL STATEMENT OF POLICY:

a. 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.

B. CRITERIA:

1. CARDIOPULMONARY CRITERIA:

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:

• 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 patient’s 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 patient’s 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 patient’s 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.

C. APPLICATION:

Direct questions about the posting of this report to Dr. Brad Truax
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Last Revised 3/20/97