A Code of Practice for the diagnosis and confirmation of death has been developed (1). The Code (1) recommends that, in the absence of (postmortem) signs, the point after cardiorespiratory arrest at which death occurs is identified by the conditions set out below:.
- simultaneous and irreversible onset of apnoea and unconsciousness in the absence of the circulation
- full and extensive attempts at reversal of any contributing cause to the cardiorespiratory arrest have been made (e.g. body temperature, endocrine, metabolic and biochemical abnormalities)
- one of the following is fulfilled:
- the individual meets the criteria for not attempting cardiopulmonary resuscitation
- attempts at cardiopulmonary resuscitation have failed
- treatment aimed at sustaining life has been withdrawn because it has been decided to be of no further benefit to the patient and not in his/her best interest to continue and/or is in respect of the patient's wishes via an advance decision to refuse treatment
- the individual should be observed by the person responsible for confirming death for a minimum of 5 minutes to establish that irreversible cardiorespiratory arrest has occurred
- the absence of mechanical cardiac function is normally confirmed using a combination of the following:
- absence of a central pulse on palpation
- absence of heart sounds on auscultation
The time of death is recorded as the time at which these criteria are fulfilled.