New Tests Help British Physicians Diagnose Death

October 21, 2008 04:40 PM
by Emily Coakley
As medical advances have made diagnosing death more complicated, Britain’s Academy of Royal Medical Colleges has recommended new tests for doctors.

Procedures Test Reflexes, Reactions

A new Academy of Royal Medical Colleges report offers doctors in the United Kingdom more guidance for diagnosing a person’s death, the BBC reports.

The report’s author, Sir Peter Simpson, said, “There are issues when people die in unusual circumstances with unusual sedative drugs on board or other extraneous things like low body temperature when it is inappropriate to confirm death. This new guidance for the first time clearly spells out when it is appropriate to diagnose death,” according to the BBC.

Instances of a dead person coming back to life are rare, the newspaper the Daily Telegraph said.

Some of the recommended tests include testing the gag reflex by putting a spatula in the back of the person’s throat, watching the pupils during “sharp changes in the intensity of light,” and “injecting ice into a patient’s ear to test for a reaction in their eyelids,” the Daily Telegraph reported.

As the number of people on transplant lists remains high, doctors must balance making an accurate diagnosis with acting quickly enough to preserve organs.

The new report emphasizes separating, “the diagnosis and confirmation of death from anything to do with the issues surrounding organ donation and transplantation. This was to avoid any concern that the diagnosis is influenced by the desperate need for life-saving donor organs which are in short supply,” according to the BBC.

Determining death hasn’t always been a clear matter in the United States, either. In a study of 38 top neurological hospitals’ brain death criteria, a study found “a wide variation,” according to Medscape.

In an interview with Medscape Neurology and Neurosurgery, the study’s lead author, David Greer, said, “It was very concerning that there was a huge mismatch between what is set forth in the practice parameters from the [American Academy of Neurology] and what is actually being stipulated at local hospitals.”

A doctor from Dartmouth-Hitchcock Medical Center wrote an editorial to go along with the report, Medscape said. In it, Dr. James Bernat recommended medical groups “jointly empanel a task force to draft evidence-based guidelines, including specific recommendations for conducting the clinical and confirmatory tests for brain death.”

The survey and editorial are in the Jan. 22 edition of the journal Neurology.

Opinion & Analysis: Challenges in diagnosing death

In a 2004 editorial in the British Journal of Anaesthesia, G.R. Park of Addenbrooke Hospital said, “Because of the difficulties in diagnosing death in patients receiving mechanical ventilation there is a need for guidance; no matter how skilful or artful any of us may be. Nobody would deny that guidelines, applied in context, are extremely valuable.”

He called upon medical leaders in the United Kingdom to update and clarify a Code of Practice on diagnosing brain stem death.

Related Topic: Declaring death for organ transplants

A New England Journal of Medicine report published earlier this year examined cases of three infants whose hearts were transplanted after they stopped beating. The controversial cases involved the donor babies being declared dead using cardiac death, not the normal brain death standard. According to findingDulcinea, “The babies had been deprived of oxygen during birth and had brain damage. The families agreed to take them off life support, and they were removed an average of four days after birth.”

Earlier this year, a California surgeon was accused “of hastening the death of a patient in order to retrieve his liver and kidneys,” according to findingDulcinea.

Reference: End-of-Life Issues Web Guide


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