Determination of Death: Experts Call for International Consensus

Photo: Anaesthesia

Anaesthesiologists participate in the decision-making around the biological death; © Olson

The criteria used to diagnose both circulatory and brain death in a patient are subject to variability and as such can be controversial. Anaesthesiologists play an important role in procedures related to the determination of death. So experts will call for international consensus.

"Before the technological advances of the last century, death was diagnosed by presence of coma, apnoea, and lack of a pulse. The failure of the cardiovascular or respiratory systems inevitably led to a person dying," says presenter Ricard Valero of the University of Barcelona, Spain.

However, the establishment of the criteria determining neurological (brain) death during the 20th century represented a significant change regarding the traditional method to define death and still is a challenge from the ethical and scientific point of view. "For this diagnosis, it is essential to demonstrate irreversible coma, absence of response to stimuli and absence of brainstem reflexes (including the capacity to breathe), once the situations that could interfere with the diagnosis have been discarded," says Valero. "However, several studies have demonstrated that there is no global consensus on what are the detailed diagnostic criteria for this determination in clinical practice, such as the number of physicians needed to agree on the diagnosis, how many and which reflexes need to be examined, length of observation periods, and use of additional tests to confirm death."

"Biological death is not an event, but a process," concludes Valero. "Anaesthesiologists participate in the decision-making around this process, and we have to establish clear and unequivocal criteria for the diagnosis of death, knowing the emerging ethical implications."

Valero says that, while every doctor should be involved in the debate in general terms, that it is most relevant to anaesthesiologists, intensive care doctors, neurologists and neurosurgeons, since they are the specialties most commonly involved in determining death in the clinical setting.

In another part of the session Doctor Alex Manara, Consultant in Anaesthesia and Intensive Care Medicine & Regional Clinical Lead in Organ Donation for the United Kingdom, will discuss the circulatory criteria to confirm death and argue that with 600,000 deaths in the UK each year and 56 million deaths worldwide, "we should know all there is to know about death." Yet unlike brain death there has been virtually no guidance until recently to standardise the circulatory-respiratory criteria.

He will say "there needs to be consensus around a practical and concrete definition of death that describes the state of human death based on measurable and observable biomedical standards". He will call for "a research agenda to address outstanding knowledge gaps in this complex field."; Source: ESA (European Society of Anaesthesiology)