Ricard Valero, senior consultant anaesthesiologist at the Hospital Clinic de Barcelona, and Dr Alex Manara, consultant in anaesthesia and intensive care medicine at Frenchay Hospital, Bristol, have called for internationally agreed guidelines and further research to prevent the rare occasions when people are pronounced dead but are later found to be alive.
Dr Manara said that there should be an agreed standard that patients are continuously observed for a minimum of five minutes to confirm absence of the circulation before declaring death, to prevent instances of someone being declared dead before their heart and lungs spontaneously recover.
Valero is concerned with the challenge of determining neurologic death, as technology allows the artificial preservation of respiration and circulation, even after the loss of brain function.
“Several studies have demonstrated that there is no global consensus on what are the detailed diagnostic criteria for brain death 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,” Valero said.
The World Health Organization has begun work to develop a global consensus.